What is a Rotator Cuff Repair?
This picture shows the shoulder joint and the rotator cuff muscles.
This is a group of muscles which wrap closely around the shoulder joint, helping to keep the joint in the correct position and control shoulder movements. The muscles attach from the shoulder blade on to the top of the arm bone. They can be damaged through general wear and tear or after an accident /fall. This usually happens close to the muscles attachment in the tendon.
Damage to one or more of these muscles can therefore lead to a loss of shoulder movement and the shoulder becomes weak and painful.
The operation aims to repair the damage to the rotator cuff. The torn muscles are repaired with sutures or suture anchors depending on the site and size of damage. The operation can be done either arthroscopically (i.e. key-hole surgery) or through an open incision. Your surgeon will discuss this with you before surgery as the approach used will be determined by the size and nature of the tear.
What are the possible associated procedures?
During your operation your surgeon will use a tiny camera to look inside your shoulder for other areas of damage. It may be necessary to do an additional procedure at the same time. These include:-
Acromio-clavicular joint excision
Excision lateral end of clavicle
What are the risks of having a Rotator Cuff Repair?
All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.
The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, re-tear of the rotator cuff
What can I do to aid the recovery process after my surgery?
Directly after surgery before you come round you will be fitted with a sling. In some circumstances you will find the sling has a small wedge under the elbow to keep your arm slightly out to the side. This reduces tension on the repaired tendon.
Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. You should wear your sling in bed for the first 2- 6 weeks. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.
Your sling is to support your arm and allow the surgical repair to heal. You will have to wear the sling for between two and six weeks following your surgery. The amount of time that you have to wear your sling for will depend on the size of the rotator cuff tear. This will be explained to you after your surgery. The sling can be removed for washing and dressing only – the Physiotherapist will advise you how to do this safely before you go home.
Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.
In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).
When will I be fit enough to return to work?
You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your hospital doctor to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 8-12 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.
How long will it be before I can start to resume my normal activities?
This will depend on the size of the rotator cuff tear and the condition of the tendons. Your surgeon will discuss the operation findings with you. In the case of a large tear you will need to refrain from heavy work or lifting for at least 12 weeks. For specific guidance regarding sport or DIY please speak to your physiotherapist.
Driving If you feel comfortable and have good range of movement you can begin driving 4 -6 weeks after your operation in the case of a small tear. In a large tear you will need to avoid driving for up to 8 weeks. It is advisable to check this with your doctor or physiotherapist if you are unsure. It is important to advise your insurance company that you have had shoulder surgery.
Will I need any follow up appointments?
You will be seen in outpatients clinic approximately 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.
If you are continuing with your physiotherapy at Spire Liverpool Hospital as an outpatient, an appointment will normally be arranged within the following week. The amount of physiotherapy you require will depend on your individual progress.