Performed by – Ankit Desai, Gareth Hill, Philip Rosell

There are 4 tendons that move the shoulder. These tendons are collectively called the rotator cuff. They are attached to the shoulder blade at one end and to the top of the humerus (upper arm) at the other end. They pass through a narrow space just before attaching to the top of the humerus. This space can become narrowed further over time due to either a bony spike developing or thickening of a ligament.

The tendons can be injured or torn by either an acute injury such as a fall or from long term wear when the tendon will gradually become thinner before eventually rupturing. The uppermost tendon, supraspinatus, is the commonest to be torn with infraspinatus at the back of the joint being the second commonest.

The treatment depends upon the size of the tear, the age and activity level of the individual and the time since the tear occurred. When a tear is present for a long time the muscles may weaken and shrink in size with fat becoming more visible within the muscle which is linked to poorer outcomes and a higher likelihood of the repair failing.

The current medical evidence supports early surgery for acute traumatic rotator cuff tendon tears in active individuals, however healing rates do diminish as we age and those over 70 generally have poorer healing and they may not benefit as much from surgery. This is very dependent on both patient and tear factors and can be discussed in detail with your surgeon.

Operative management
Rotator cuff tears can be repaired by both arthroscopic (keyhole) and open techniques. There is no difference in the outcomes and success rates whether your surgery is open or arthroscopic. In both techniques the tendon is repaired by securing it back down to the bone it has torn off using sutures. These are secured in the bone using suture anchors (often screws or other devices which grip in the bone), or tunnels drilled into the bone.

For open surgery 4-8cm incision is made on the side of the shoulder whereas for arthroscopic many small incisions may be used to allow instruments and sutures to be placed accurately.

The surgery is normally performed under general anaesthetic with early post operative pain can be controlled by a nerve block in the base of the neck. This can be discussed with the anaesthetist prior to the operation.

Post-operative management
Most operations are performed as a day case but occasionally you may stay in hospital for one night if required.

Your arm will be rested in a sling for comfort and this will be maintained for up to 6 weeks. Occasionally an accelerated programme can be initiated but this is specific to every case and your surgeon will discuss if this is appropriate for you and your repair. You will be provided with instructions to protect the repair but allow some early supported movement to try to prevent early stiffness.

Between 2 and 6 weeks physiotherapy is started to regain movement in the shoulder. At around 6 weeks after surgery, you’ll be encouraged to remove your sling and progress to full movement as comfort allows. You should be able to restart driving after about 2 months. At approximately 12 weeks post surgery strengthening exercises are started as the repair is now strong enough to begin building muscle strength.

After 4 months some sports can be restarted, but heavy lifting and contact sports should be avoided until 6 months after surgery. Recovery from this surgery can take a while and you may continue to see improvements in your shoulder function up to 18 months post surgery.