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Rotator Cuff Tear & Surgery

Anatomy of the Rotator Cuff

Anatomy of the Rotator Cuff

The rotator cuff is a group of 4 muscles in the shoulder joint including the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles originate in the scapula and attach to the head of the humerus through tendons. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing stability to the shoulder joint while enabling a wide range of movements.

What are Rotator Cuff Tears?

Rotator Cuff Surgery

Injury to the rotator cuff may occur due to pressure on the rotator cuff from part of the shoulder blade (scapula). It may occur due to repeated use of the arm for overhead activities or while playing sports. A forceful injury such as trauma can cause one or more of these tendons to tear, a condition called rotator cuff tear. This is one of the most common causes of shoulder pain in middle aged adults and older individuals.

Causes of Rotator Cuff Tears

A rotator cuff tear may result from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents.

The common causes for a tear in the rotator cuff include:

  • A blow or injury to your shoulder
  • Sudden excessive loading of the joint such as while lifting an object
  • Sports such as baseball and tennis which can lead to overuse
  • Excessive overhead activities such as carpenters and painters
  • Bone spurs on the acromion
  • Tendon degeneration due to aging

What are the Common Symptoms of Rotator Cuff Tear?

The most common symptom of a rotator cuff tear is pain that is usually over the outer and front portion of the shoulder. It is typically worse when your shoulder is moved in certain positions. Other symptoms include:

  • A dull pain deep in the shoulder
  • A tearing sensation or popping sound in your shoulder
  • Muscle weakness, particularly when lifting the arm
  • Pain in the night that stops you from sleeping on the affected side

What are Massive Rotator Cuff Tears?

A tear in the rotator cuff can cause pain and disability. It can occur from degeneration of the rotator cuff due to overuse or from a sudden injury. Massive rotator cuff tears involve tears in two complete tendons of the rotator cuff. A tear of more than 5 cm is described as massive. A massive tear may be associated with degeneration and retraction of the tendon and can be difficult to repair if treatment is delayed.

Complications of Massive, Retracted Rotator Cuff Tears

Massive rotator cuff tears may be associated with:

  • Fatty infiltration of muscle (accumulation of fats) causing loss of elasticity
  • Humeral head subluxation (partial dislocation)
  • Impingement of tissues
  • Formation of bone spurs
  • Osteoarthritis

What is Rotator Cuff Surgery?

Rotator cuff surgery is a surgical procedure to repair an injured or torn rotator cuff. The surgery may be performed as an open procedure or arthroscopically, depending on the severity of the tear.

When Do I Need Rotator Cuff Surgery?

Your doctor may recommend a rotator cuff surgery in the following scenarios:

  • Your symptoms have lasted for 6 to 12 months
  • You have a significant loss of function and weakness in your shoulder
  • You are an athlete and wish to return to sports soon
  • Your rotator cuff tear is larger than 3 centimetres
  • Non-surgical treatments have failed to alleviate symptoms

What are the Preoperative Preparations Involved with Rotator Cuff Surgery?

In general, preoperative preparation for rotator cuff surgery may include:

  • A thorough history and physical examination
  • Routine blood work and imaging
  • Refraining from certain medications like blood thinners, aspirin, or NSAIDs
  • Informing your doctor of any allergies to medications, anaesthesia, or latex
  • Refraining from solids or liquids at least 8 hours prior to surgery
  • Arranging for someone to drive you home following surgery
  • Signing a consent form after the risks and benefits of the surgery have been explained

How is the Rotator Cuff Surgery Performed?

Rotator Cuff Surgery

Rotator cuff repair can be accomplished either arthroscopically or with a traditional open surgical approach.

Arthroscopic Repair
Rotator cuff surgery is usually performed arthroscopically. This is a minimally invasive surgery performed through tiny incisions, about 1 cm each, with an arthroscope - a small fibre-optic viewing instrument made up of a tiny lens, light source, and video camera. The surgery is performed under general or regional anaesthesia and involves the following steps:

  • 2 to 3 incisions are made on the skin near the shoulder joint.
  • An arthroscope is inserted through one of the incisions.
  • The camera attached to the arthroscope displays the image of the joint on a monitor, allowing your surgeon to determine the amount of damage and type of injury present. Miniature surgical instruments are inserted through the other incisions to remove the damaged part of the tendon and injured surrounding tissue.
  • The damaged ends of the tendon are sewn together. A suture anchor may be used to reattach a completely torn tendon to the bone. 
  • The incision is closed and covered with a bandage.

Open Repair

A traditional open surgery is warranted if the rotator cuff tear is large or complex. The surgery is done under regional or general anaesthesia. A large incision is made over the affected shoulder joint and the underlying muscles are separated to expose the rotator cuff. The extent of rotator cuff damage and type of injury is assessed, and suitable correction is carried out accordingly. The incision is closed and covered with a bandage. 

How Long Does the Surgery Take?

An arthroscopic rotator cuff surgery may take around 1 to 1.5 hours, whereas an open surgery may take around 1.5 to 2 hours. Surgery time may vary slightly based on the complexity of your injury and the procedures required.

How Many Days of Hospital Stay Do I Need After Surgery?

For an arthroscopic rotator cuff surgery, you may need an overnight stay in the hospital and then discharged on the following day, whereas an open surgery may require at least 2 to 3 days of hospital stay.

What Does Recovery Involve after Rotator Cuff Surgery?

After the surgery, pain medications and antibiotics are prescribed to control pain and prevent infection. You may also apply ice packs on the shoulder to help reduce swelling and pain. Your arm will usually be secured in a sling/immobiliser for 4 to 6 weeks to facilitate healing and protect the repair. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You should avoid strenuous activities and lifting heavy weights for a time specified by your doctor or physical therapist. Instructions on surgical site care and bathing will be provided to keep the wound clean and dry. You should be able to perform gentle daily activities in a couple of weeks after surgery. You can expect to return to the office/work in 2 weeks, return to driving after 2 months, and fully recover by 3 to 6 months.

What are the Benefits of Rotator Cuff Surgery?

The benefits of arthroscopic repair compared to open repair, include the following:

  • Smaller incisions
  • Minimal soft tissue trauma 
  • Less pain
  • Lower infection rate
  • Less scarring
  • Earlier mobilisation
  • Shorter hospital stay

What are the Risks and Complications of Rotator Cuff Surgery?

Rotator cuff surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Infection
  • Bleeding
  • Inflammation
  • Damage to nerves or blood vessels
  • Blood clots or deep vein thrombosis (DVT)
  • Shoulder stiffness
  • Allergic or anaesthetic reactions

 

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