What is rotator cuff surgery?
Rotator cuff surgery is carried out to repair a torn rotator cuff and/or general rotator cuff damage.
Surgery may be recommended when non-surgical methods, such as physiotherapy or steroid injections, haven’t worked.
What is the rotator cuff?
The rotator cuff is one of the most important parts of the shoulder. It's formed from four muscles and tendons that attach your arm to the top of your shoulder blade (see figure 1). It allows you to lift your arm and reach up, as well as stabilising the shoulder joint for normal shoulder movements. Essentially, the rotator cuff keeps your shoulder in its socket.
What causes damage to the rotator cuff?
Damage to the rotator cuff can be caused by a number of factors. It can become injured after a fall or an accident, or from repetitive movements or overuse of the shoulder. This is especially common in sports that involve overhead actions, such as tennis, swimming and weight-lifting.
Another cause is wear and tear. This is more likely to happen to older patients due to inflammation or damage to muscles and tendons in the shoulder over time.
What are the benefits of rotator cuff surgery?
The main benefits of rotator cuff surgery are to relieve pain and to allow you to use your shoulder more easily. Having surgery can restore function, improve your mobility and increase your range of movement.
Ultimately, successful surgery can help you return to your normal activities.
Are there any alternatives to surgery?
If the tear or impingement is quite small, then the symptoms can often be managed with physiotherapy and/or anti-inflammatory painkillers. Another non-surgical treatment is steroid injections, which can also help to manage the pain. However, physiotherapy is usually the first port of call before considering surgery.
If you have a large tear, are experiencing recurring pain, or have limited arm mobility and muscle weakness in the shoulder area, and physiotherapy has failed to control your symptoms, then rotator cuff surgery may be the most appropriate solution.
What does rotator cuff surgery involve?
Depending on the extent of your injury, rotator cuff surgery can be performed as open surgery or by arthroscopy, also known as keyhole surgery.
Arthroscopy involves inserting a small camera, called an arthroscope, through a few small incisions, and passing surgical instruments through these incisions to treat the shoulder joint.
If you have a larger tear, open surgery may be required and a larger cut over your shoulder will be made. Bone spurs may also be removed to prevent the rotator cuff tendons from rubbing against the bone.
The surgery itself is usually performed under a general anaesthetic, however a variety of anaesthetic techniques are possible.
During the surgery, your surgeon may use instruments to remove any thickened tissue, release any tight tissue and to shave off some bone. If you have a large tear, your surgeon will repair the rotator cuff using stitches that anchor into the bone.
What complications can happen?
Any surgical intervention has risks of complications such as pain, extensive bleeding, unsightly scarring or infection in the surgical wound. Complications specific to rotator cuff surgery include:
- Bleeding into the shoulder
- Restricted shoulder movement
- Infection in the shoulder
- Blood clot
- Severe pain, stiffness and loss of use of the arm and hand
- Nerve injury
How long will it take to recover?
The immediate recovery period depends on the type of anaesthetic you’ve been given, but in some cases it’s possible to go home on the same day. Your ward team and physiotherapist will give you instructions on your post-operative exercise regime and functional advice.
Once you’re back in the comfort of your own home, it is important to follow advice on how to keep the surgical wound dry and clean. To help manage any pain you may experience, your consultant may prescribe pain relief medication.
You’ll need to attend regular physiotherapy sessions and perform your prescribed exercises at home.These exercises will help you to increase your range of movement, function and strength. After approximately two weeks, the stitches or clips can be removed. However, it can take up to a year to make a full recovery in terms of building enough strength in your shoulder to return to normal activities.
Regular exercise can help to speed up your recovery, but before you start exercising, you should ask a member of the healthcare team for advice.