Rotator cuff repairs

Surgery to repair a torn rotator cuff involves stitching the tendon back onto the upper arm bone (humerus). If the tendon is only partially torn, a procedure called a debridement may be used to trim and smooth the tear.

There are several types of rotator cuff repair surgery:

• Open repair involves making an incision several centimetres long over your shoulder. Any bony spurs will be removed from the underside of the acromion. Open repairs are generally not required but may be used for large or complex tears if an additional reconstruction procedure is needed.
• Mini open repair uses arthroscopy to assess and treat damage to other structures within the joint, such as bony spurs. Once these procedures are complete, the surgeon repairs the rotator cuff through a mini open incision. The benefit of this procedure is that there is less soft tissue damage than full open repair, making recovery speedier than with traditional open surgery.
• All-arthroscopic repair uses keyhole surgery. A tiny camera called an arthroscope is inserted into your shoulder joint through a small incision. It allows the surgeon to see inside your joint. By looking on a video screen your surgeon can carry out the repair using miniature surgical instruments, which are inserted through a separate incision. Because this is a minimally invasive procedure, recovery is normally quicker than with open surgery.
• In some cases, if there is massive, irreparable damage to the rotator cuff you may be offered an innovative treatment called superior capsule reconstruction. This is an arthroscopic procedure that can be used to improve function and reduce pain. Previously, the only option for irreparable rotator cuff tears was tendon transfer, but results were mixed and there were frequently complications.

Superior capsule reconstruction utilises a donor graft, which is attached to the superior glenoid (the socket side of the shoulder joint) to stabilise the head of the humerus and help it rotate more effectively. Early studies have shown good patient satisfaction levels, with an increase in range of movement and strength and a reduction in pain levels. Rehabilitation for this procedure is generally slow with six weeks in a sling and gradual improvement in strength over twelve to sixteen weeks. Slow rehabilitation is important to promote healing and reduce the risk of graft failure.

The type of surgery that you are offered will be determined by the size of the tear and condition of your tendons and bone. You may be offered another procedure alongside the rotator cuff repair if you have other conditions such as osteoarthritis, tears to the biceps tendon or bony spurs which require treatment. Most surgical repairs can be done as a day case procedure without needing to be admitted to hospital.

You might require rotator cuff surgery if you have torn your rotator cuff as a result of repetitive overhead movements or heavy lifting. Among the factors that put you at risk of rotator cuff injury are:

• Construction jobs that require repetitive overhead arm motions that can damage the rotator cuff over time
• Family history – genetic factors may predispose you to rotator cuff injuries
• Sports such as basketball and tennis
• Age – the risk of rotator cuff tears increase in people over the age of 40

Immediately after surgery you are likely to feel pain and will be prescribed short-term pain relief. If the pain has not improved within a few weeks you should talk to your consultant. Your arm will need to be immobilised after surgery to protect the tendon while it heals. You should wear a sling and avoid using your arm for activities, other than those shown to you by a physiotherapist, for four to six weeks. A physiotherapist will suggest gentle exercises to improve the range of motion in your shoulder. You will normally do these in the first four to six weeks, after which you will progress to more active exercises designed to increase strength gradually. Twelve weeks after surgery you will begin a strengthening programme of exercise. It may take four to six months before you have developed a functional range of movement and longer for complete recovery. Rehabilitation exercises are the key to a successful outcome.

Most people report an improvement in shoulder strength and a significant reduction in pain after rotator cuff repair surgery. A range of factors will influence the success of surgery, such as the extent of the damage, your age, whether or not you smoke, the quality of the tissue in your shoulder and how well you follow the rehabilitation programme and consultant instructions after surgery.