Rotator cuff surgery is performed to repair torn or damaged tendons in the rotator cuff, a group of muscles and tendons that stabilise the shoulder and facilitate its movement. This guide delves into the anatomy of the rotator cuff, common injuries, when surgery may be required, the different types of surgical procedures, how to prepare, the surgical process itself, and what to expect during recovery. It also addresses potential risks and complications to help you make well-informed decisions about your treatment.
Symptoms Indicating a Rotator Cuff Injury
Symptoms of rotator cuff injuries can affect daily activities and include:
Pain: This can range from a dull ache to sharp pain, particularly when lifting or lowering the arm, reaching behind the back or lying on the affected shoulder.
Weakness in the Shoulder: A rotator cuff injury can cause shoulder weakness, making lifting or carrying objects difficult. This weakness can also affect the ability to perform simple tasks, such as brushing hair or reaching for items on a shelf.
Limited Range of Motion: Rotator cuff injuries can result in a limited range of motion in the shoulder, making arm movements in certain directions painful and making it difficult to engage in activities that require full arm movement.
When is Rotator Cuff Surgery Recommended?
Non-surgical treatments such as rest, physical therapy, and medications can be effective for minor injuries but may not suffice for severe tears or persistent symptoms. Rotator cuff surgery is advised for severe tears, persistent pain that does not improve with non-surgical treatment, loss of shoulder function that affects daily activities, or a completely torn tendon due to injury. The decision to perform surgery is based on a thorough evaluation by a surgeon, the injury’s severity, the patient’s overall health and specific needs.
Types of Rotator Cuff Surgery
Arthroscopic Surgery: Arthroscopic surgery involves making small incisions and using a camera (arthroscope) and specialised instruments to repair the rotator cuff. This method typically results in less pain, smaller scars, and a faster recovery compared to traditional surgery.
Mini-Open Repair: This procedure uses both arthroscopic and open surgery techniques, with the surgeon performing an arthroscopy to assess the damage, then making a larger incision for the repair. This method is used for larger tears that require a more extensive repair than arthroscopy alone.
Open Repair: Open repair involves a larger incision to directly access and repair the rotator cuff. This procedure is used for complex or large tears that cannot be treated with less invasive methods and usually involves a longer recovery time.
The Procedure
The procedure typically takes 1 to 2 hours. Factors such as the size of the tear, the complexity of the repair, and the patient’s anatomy can influence the procedure time.
Pre-procedure Preparations
During a pre-surgery consultation, your doctor reviews your medical history and may order imaging tests, such as an MRI or X-ray, to evaluate the injury. Some medications may need to be adjusted prior to surgery and you will likely be instructed to fast the night before the procedure. Additionally, it is helpful to prepare your home for limited mobility, such as by arranging pillows to support your arm and gathering necessary supplies for recovery.
The Surgical Process
Anaesthesia: General or regional anaesthesia is administered based on patient needs.
Incision and Arthroscope Insertion: Small incisions are made around the shoulder, and an arthroscope (a small camera) is inserted to visualize the joint.
Repair Technique: Specialized surgical instruments are used to remove any damaged tissue, reattach the torn tendon to the bone, and secure it with sutures or anchors.
Closure: Once the repair is completed, the incisions are closed with stitches or surgical staples, and a sterile dressing is applied.
Immediate Post-Operative Care
After surgery, the patient is monitored in a recovery room until the anaesthesia wears off, which is necessary to ensure that there are no immediate complications and that the patient is stable. Pain is managed with prescribed painkillers and anti-inflammatory medications and ice packs may be used to reduce swelling and discomfort. Rest and minimal movement of the shoulder are advised during this time to allow initial healing.
Potential Risks and Complications
Rotator cuff surgery carries some risks and complications but taking precautions can reduce these risks and support recovery.
Infection: Infection at the surgical site can develop but can be prevented by keeping the area clean and dry. Symptoms of infection include redness, warmth, or discharge.
Nerve Damage: There is a small risk of nerve damage during surgery, which can cause numbness, tingling, or weakness in the shoulder or arm.
Stiffness: The shoulder joint can become stiff after surgery. Strictly adhering to your physical therapy programme can help manage this.
Tendon Re-Tearing: The tendon may re-tear, especially if the shoulder is overused during recovery but following your rehabilitation plan closely can help prevent this.
Conclusion
Rotator cuff surgery is an effective treatment for restoring shoulder function and relieving pain caused by severe injuries or chronic conditions. While the recovery process can be lengthy and requires dedication to rehabilitation, most patients regain strength and mobility with proper care. By learning about the procedure, preparing thoroughly, and following your surgeon’s advice, you can optimise your recovery and return to your daily activities with improved shoulder health.
Schedule a consultation with Dr LS Wang today to determine if rotator cuff surgery is right for you and discuss your personalised treatment options.
