Introduction
The aim of surgery is to identify and repair the torn tendons back to bone. In addition to this, any inflamed bursa tissue is resected (bursectomy).
Indications
Surgery is indicated in a number of settings:
- Failure to improve after non-surgical therapy
- A new traumatic tear causing loss of function, movement and strength
- A larger old tear causing pain, loss of function, movement and strength
Patients with partial tears or small full thickness tears (<1cm) can tolerate longer period of trial of non-operative management.
Procedure
This is performed as an all arthroscopic (keyhole) with possible addition of a small open incision.
Surgery is performed under general anaesthesia. An additional nerve block may be used to numb the arm for 6-12 hours after surgery.
Rotator cuff surgery begins with an inspection of the shoulder joint as well as cuff tendons and biceps.
Anchors loaded with sutures are inserted, sutures are passed through the cuff tendon and the tendon is approximated to the bone and tied.
Postoperatively, the patients are placed in a sling. Most patients require 1-night stay in hospital.
Recovery
Patients stay 1 night in hospital
Generally, rehabilitation is divided into three phases:
- Phase 1 (0-6 weeks): Fulltime in a sling. No driving. Gentle passive exercise.
- Phase 2 (6-12 weeks): Exercises to improve range of motion.
- Phase 3 (>12 weeks): Strengthening exercises.
Patients will continue to show improvement up to 1-2 years post-surgery.
Results
Patient Satisfaction after rotator cuff repair is around 90-95%.
Factors that reduce the rates of success include:
- Larger tears.
- Poor tendon quality.
- Workers compensation status.
- Patient age >65 (~20% re-tear rate).
- Smoking.
Risks and Complications
These include:
- Stiffness.
- Re-tear of the tendon.
- Infection.
- Excess Bleeding.
- Nerve injury.