Definition & Overview

Rotator cuff repair is a surgical procedure used to fix a tear in the muscles and tendons that hold the arm in its joint. These tendons are also used to facilitate shoulder movements.

The rotator cuff connects the upper arm, also called the humerus, to the scapula or the shoulder blades. The muscle component allows flexibility for movement while the tendons in the cuff are responsible for anchoring and stabilising the shoulder.

A rotator cuff tear usually involves the tendons while an injury typically leads to the inflammation or irritation of both the muscles and tendons. A rotator cuff tear usually results from wear and tear or injury. This condition does not immediately exhibit any symptoms, especially during its early stages. A partial tear in the affected part does not immediately necessitate repair. In some cases, the patient may be asked to try other alternative treatments to address their condition.

Who Should Undergo and Expected Results

Patients suffering this orthopaedic condition may be offered to undergo surgical repair if they have been experiencing rotator cuff pain (particularly during rest or sleep) for several months and have tried other nonsurgical treatments but have not achieved relief.

Patients who typically undergo torn rotator cuff surgery are:

  • Athletes with a torn rotator cuff, which can result in significant loss of shoulder functions and pain when lifting objects

  • Those who rely on the active use of their shoulder (such as those who do manual labour) to avoid losing their means of living.

  • Those who experience sudden injury and trauma to the shoulders, especially if the condition is not brought about by the usual wear and tear.

The procedure has a high success rate, particularly for those whose condition is brought about by a rotator cuff injury. In some cases where the patient experience gradual tear of the tendons, complete restoration of shoulder function and mobility may not be achieved. The procedure is typically followed by a series of physical therapy sessions to encourage the healing process and restore the strength of the affected part. During the first few weeks after rotator cuff surgery, minimal use of the affected shoulder is advised. This means no strenuous activities, as the arm is placed in a sling. Over time, patients experience relief of symptoms and improved mobility of their shoulders.

How is the Procedure Performed?

There are several approaches for performing shoulder surgery. These include arthroscopic, mini-open, and open surgical techniques.

Prior to the procedure, the patient is administered with either general or local anaesthesia. In the arthroscopic technique, small incisions are made at the surgical site. A small tube called the arthroscope is inserted to provide visualisation on the affected part. Other specialised surgical tools are also inserted to introduce the suture and tie the two ends of the torn tendons. This procedure is repeated as necessary until the tear is repaired. Suture anchors are also placed on the rotator cuff for stability. The surgical tools and the arthroscope are then retracted.

During the mini-open procedure, an arthroscope is also used for visualisation and the removal of any damaged tissue. If bone spurs are present, they are also removed before the surgeon makes another incision to access the torn tendon. The tendons are then sutured and repaired accordingly.

For large tears, the surgeon may opt to perform the open-surgical repair technique where a large incision is made over the affected part. The deltoid muscle is detached and moved to gain better access to the torn tendon. The surgeon then proceeds to suture and repair the tear, removing any bone spurs that developed. The deltoid muscle is then reattached before the incision is closed. Depending on the extent of damage, rotator cuff surgery recovery can take anywhere from a couple of weeks to several months.

Possible Risks and Complications

As in any surgical procedure, the patient may experience an adverse reaction to anaesthesia. There is also the risk of excessive bleeding and infection of the surgical site.

Following an open surgery, there is the possibility for the deltoid muscle to become detached and may not heal properly during post-operative rehabilitation. This could affect the overall functioning of the shoulder.

Stiffness of the affected muscles is also another possible complication. If not addressed, this could become permanent and result in reduced mobility.

Though rare, injury to the nearby nerve supporting the deltoid is also reported.

There is also the possibility of the tendons being torn again after a significant period of time, or when the patient injures the affected part again. This would necessitate another surgical repair.

References:

  • Beasley Vidal LS, et al. (2007). Shoulder injuries. In PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 118-145. New York: McGraw-Hill.

  • Lin KC, et al. (2010). Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al., eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986-1015. Philadelphia: Saunders Elsevier.

  • Murphy RJ, Carr AJ (2010). Shoulder pain, search date August 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

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