This is a surgical operation to re-attach a torn tendon within the shoulder back to the bone. It is usually performed as a keyhole arthroscopic technique under general anaesthetic with an interscalene block. An interscalene block temporarily numbs the nerves supplying the shoulder and arm is also usually performed to provide good post operative pain relief. When the patient wakes up from surgery their arm will feel numb with little movement possible due to the nerve block and this will last for a number of hours (on average eight to twelve hours) following the surgery. The day following the surgery the nerve block should have worn off and the patient’s pain controlled with oral painkillers. Regular simple anti-inflammatory painkillers are advisable for the first few weeks and the use of an ice pack on the shoulder may be helpful to keep the shoulder comfortable over the first week. The patient will often stay overnight in hospital following the procedure but can go home on the same day if fit and safe to do so. Arthroscopic repair of the tendons is performed via a number of small 1cm incisions over the shoulder.
During the operation all inflamed tissue within the shoulder joint is excised, the torn rotator cuff tendon is mobilised and is then repaired back to the bone. Anchors are placed into the bone of the humeral head and high-tensile sutures are tied through the torn tendon which is then repaired back down on to the bone. An acromioplasty subacromial decompression is performed to excise the undersurface of the shoulder tip (acromion) which gives the replaired tendon more space and provides blood cells to potentially assist the tendon repair to heal. At the end of the operation the patients arm is immobilised in a sling.
An anchor is inserted into the bone with high tensile sutures pre-loaded within it which will be used to stitch the torn tendon back to the bone
Anchors are inserted into the bone and then the sutures are passed through the torn tendon
The sutures are tied to repair of rotator cuff tendon tear against the bone
The outcome from a rotator cuff repair is usually excellent in terms of long term pain relief and restoration of strength in the shoulder. Following a rotator cuff repair there is a lengthy rehabilitation process during which the patient is guided by their therapist. Please the rehab section of the website for the post-operative rehabilitation protocol.
The risks of surgery include a general anaesthetic, infection, nerve damage, stiffness, and re-tear of the tendon (most common risk). The risk of the tendon re-tearing increases with patient age, size of the initial tear, extent of retraction and extent of fatty infiltration of the muscle belly of the tendon which is indicative of how healthy the muscle itself is.
The sutures which are used to close these small incisions are removed two weeks following the operation. The shoulder will be immobilised in a sling for up to six weeks and it will be at least two months before the patient can return to driving. If the patient is recovering well following surgery then they can start gentle breast stroke swimming two months following the surgery and consider returning to golf at a minimum of three months following the surgery. The patient may return to manual work between four to six months following the surgery, but this depends on each individual case and is also related to progress of recovery, repair quality and the size of the repair.