Arthroscopic Rotator Cuff Repair

Rotator cuff tears are a tear in one or more of the 4 muscles that help control the shoulder. They can be due to a traumatic event but they are more commonly due to deterioration in the muscle with age. They are commonly associated with pain in the shoulder and upper arm and weakness with certain movements of the arm

The cause of traumatic tears is due to an overload of force placed on the muscle so that it fails. Rotator cuff tears that as a result of deterioration in the quality of the muscle are less well understood. Most health professionals believe that there are multiple causes. In some cases there is a mechanical cause where the rotator cuff muscles pinch against the undersurface of the acromion. This is usually because of a bony spur on the undersurface of the acromion. This repeated pinching causes inflammation and pain and in some people can lead to the muscle tearing.

Rotator cuff tears are diagnosed by taking a detailed history of your symptoms, including when they started, whether there was any preceding event, where the pain is and what makes it worse. A thorough clinical examination is then performed, which involves finding out what movements reproduce your pain and whether you have any weakness. You will also have an X-ray to confirm the shape of your bones and to ensure there are not any other diseases such as osteoarthritis. Some patients will need further imaging such as an ultra-sound or MRI to examine the rotator cuff muscles, not all patients will need to have this performed though.

If your rotator cuff tear is due to a traumatic event it is likely that the health professional will advise you to have it repaired if technically possible. Patient Information Sheet Arthroscopic Rotator Cuff Repair If your tear is secondary to the muscle failing over a prolonged time then, first line treatment is physiotherapy to improve the control of your shoulder and the strength of the shoulder muscles. If this is unsuccessful or if the disease is severe, an injection into the subacromial space to improve the inflammation may be performed, which is then followed by physiotherapy. If you still have significant symptoms after first-line treatment, your surgeon may offer you an operation. Your chance of success is improved if your injection provides you with some pain relief, even if this is only for a few hours.

Firstly, your shoulder will be assessed whilst you are under anaesthetic to check your range of movement and the stability of your shoulder. Through key-hole incisions your shoulder will be reassessed and the operation performed. The inflamed tissue will be removed and if necessary the under surface of the bone shaved smooth to create more space for the shoulder to move with less pain. The torn muscles will be prepared and re- attached to the bone using small bone anchors. The surgical procedures will be thoroughly discussed with you as various options may change your post- operative rehabilitation.

Surgery is a successful method of treating patients with symptomatic rotator cuff tears. How well you do from surgery is affected by many factors including general health, age, size of tear and quality of the muscle. Surgery will only be performed if you have not improved from first line treatments described above.

Some of the possible complications of arthroscopic rotator cuff surgery are listed below: Infection: Infection can complicate any surgery. It may be possible to treat this with antibiotics alone, but further surgery may be required. The chance of this happening is about 1%. Stiffness: Post-operative stiffness can occur. It is important that you work with the physiotherapist to try and avoid this. Reoccurrence: Unfortunately a proportion of repairs fail if the muscle does not heal to the bone Nerve and blood vessel injury: There is a very small risk of damage to nerves or blood vessels around the shoulder. Cardiovascular problems such as heart attack and stroke, and also blood clot formation, can very occasionally be caused by anaesthesia and surgery. If there are any reasons why you would have an increased risk of these occurring, your anaesthetist will discuss this with you, and take steps to minimise the risks.

Arthroscopic rotator cuff surgery can usually be undertaken as a day case. You may need to stay overnight if you are not operated on until late in the day, or if you have other medical illnesses that need monitoring after your operation.

Initially you will be required to wear a sling to protect your repair. You will be assessed by a physiotherapist on the ward who will ensure you are able to undertake your post-operative exercises correctly to maximize the benefit of the operation. You should continue these exercises as directed until you are assessed again by an outpatient physiotherapist within two weeks of your discharge. Please keep the wounds dry to decrease the chance of infection. The wounds will be reviewed at your two week post-op out-patient clinic visit. The sutures will also be removed. Range of movement will also be assessed at this visit to ensure you have not developed any post-operative stiffness. If you feel unwell or are concerned after the operation you should seek medical attention through your GP You should only move your arm as directed by your physiotherapist. This is to protect your repair to give you the best chance of the tear healing.