Introduction
Rotator cuff repair is a procedure to repair damage and injury to the tendons in the rotator cuff surrounding the shoulder joint – also known as a rotator cuff tear.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made. No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g.water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts / tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
Rotator cuff repair procedures are generally performed using arthroscopic 'minimally invasive' repair techniques (although they can also be performed via conventional 'open tendon repair' or in some cases a combination of these two approaches).
The procedure is conducted under a general anaesthetic and in some cases an anaesthetic nerve block which keeps pain levels down for the 48-hour post-operative period.
The procedure itself involves a 5-8cm incision to access the rotator cuff, and then the large deltoid muscle is moved to one side to gain access to the bone and tendons. If there are any apparent bone spurs which may be impacting the tendons, these are removed. Tendons with tears are repaired using 'suture anchors' which are affixed to the positions on the bone where the tendons usually attach. These suture anchors can be a type that dissolves after a period of time or they can be permanent (permanent ones are normally made of metal). Normal sutures are then used to attach the tendons to the new anchors. Natural body processes gradually help to strengthen these repairs over time.
Postoperative instructions
Recovery from a rotator cuff tear repair procedure can take 4-6 months in total, during which time patients must follow a rehabilitation program involving physiotherapy and regular shoulder exercises in order to return to normal shoulder strength and range of motion and make a full recovery.
This program generally runs for at least 3 months after surgery. More details on the rehabilitation program will be given to you after surgery.
On discharge after the procedure a sling must be worn for at least 4-6 weeks.
Risks
As with any surgery, there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
Some specific risks of cuff repair are that, in some cases, some of the original symptoms may remain (such as weakness and stiffness and a degree of pain). This can be the case where:
- The patient is aged over 65.
- The patient smokes.
- The patient has not followed the rehabilitation program.
- The patient had large cuff tears.