Rotator cuff repair surgery Q&A with Mr Ben Gooding

Ben GoodingMr Ben Gooding is a Consultant Orthopaedic Surgeon at BMI The Park Hospital

We caught up with Mr Ben Gooding to ask him a few questions about rotator cuff repair surgery, covering what the procedure involves and the benefits of it.

Mr Gooding is a Consultant Shoulder and Elbow Surgeon at BMI The Park Hospital in Nottingham. As well as rotator cuff repair surgery, Mr Gooding's specialises in shoulder and elbow sports injuries, soft tissue injuries and fractures, repetitive use injuries and degenerative conditions including arthritis. 

Rotator cuff repair surgery is repairing torn tendons in the shoulder using a combination of stitches and small darts or anchors into the bone. The rotator cuff is made up of four main tendons, which form a broad hood or sheet around the top of the shoulder. They enable you to lift and rotate your arm.

It’s most commonly done with keyhole surgery (arthroscopic) and many patients in my practice stay awake during their procedure with the opportunity to watch the operation on a computer screen.

I am very fortunate to work with anaesthetists who are considered the UK's leading experts in regional anaesthesia for shoulder and elbow surgery. This means surgery can often be done with only the required area anaesthetised avoiding many of the risks of a major general anaesthetic.

There are 3 main types of rotator cuff tear: 

  • In younger patients (normally over 40) who sustain a bad injury on a previously normal shoulder and tear the tendons. This is called an acute tear – these tears are best repaired within a few months of injury 
  • Patients who may be slightly older and have had some grumbling shoulder trouble, but sustain an injury which tears a previously worn tendon. This is called an acute on chronic tear – these can sometimes be managed with physiotherapy and injections, but if not settling require surgical repair
  • Older patients who have developed wear and tear in the tendons over many years, resulting in the tendons failing – these chronic tears can require repair, but at times are too badly damaged and a replacement type procedure may be required

The procedure can be done as a day case or a short one night stay. After the anaesthetic, you’ll be placed on an operating table in the shape of a deck chair and special equipment including a small camera the size of a pen and other devises to insert stitches and anchors will be used. This involves two or more small cuts around the shoulder of 1cm each. The operation takes between 30–60 minutes.

The main benefit is to reduce the pain which can be particularly bad at night. As the tendon heals and time passes, the strength in the shoulder should also improve.If torn tendons are left unattended the tears can get worse and eventually in a small number of cases lead to arthritis.

Physiotherapy and injections are often used for people with acute, on chronic or chronic tears. These can be very successful if the tear is small and other muscles around the shoulder compensate.

All surgery carries some risk and any patient undergoing this operation will have the opportunity to discuss these during the consent process.

These risks are kept to a minimum by using regional anaesthetic techniques and keyhole surgery which, both reduce the aesthetic risks as you can maintain your own breathing supply and bloody supply to the brain during surgery. Keyhole techniques also reduce unwanted damage to tissue around the shoulder and the wounds are much smaller.

One of the common risks is developing a frozen or stiff shoulder after surgery (1 in 10), but this can be treated fairly easily in the clinic in most cases. Another potential risk is failure of the repaired tendons to heal or a further tear with subsequent injuries.

Initial recovery is quick, with return to home usually within 24 hours. A sling will be required, however for around 6 weeks, and this can be quite challenging. The pain can be worse during this period and we advise patients that the main recovery will take at least 3 months. 

For example, you will be unable to drive for a minimum of 8 weeks and will need to avoid heavy manual tasks during this period. This reflects the length of time it takes for tendons to heal back to the bone, but Physiotherapist will supervise your rehabilitation at this time.

I love the combination of treating a wide variety of patients alongside the huge rewards for the technical challenge of doing surgery.

I’ve treated a number of famous individuals and professional sports players, which is hugely rewarding. However, the biggest highlight of my career is seeing someone back after surgery that has lived in pain for many years and can now return to a normal life - pain free.

BMI The Park provides a range of orthopaedic services including rotator cuff surgery, hip replacement surgery and treatment for sports injuries.