The rotator cuff is a group of four tendons that wrap around the shoulder and allow the shoulder such significant range of motion.
Rotator cuff pathology is one of the most common shoulder conditions affecting the adult population. It can range from sub-acromial bursitis and impingement to tendon thickening and partial tears all the way to full thickness tears where the tendon has pulled completely away from the bone.
Most rotator cuff pathology is the result of accumulated wear, tear and degeneration as we age and use our shoulders. Sub-acromial bursitis and impingement can often be managed very effectively without surgery using targeted physiotherapy, sometimes facilitated by a cortisone injection into the subacromial bursa. Partial thickness and even small full thickness tears can also often be well compensated by good rehabilitation of the remaining, intact rotator cuff tendons. Once non-operative management is no longer achieving a satisfactory outcome, surgery can be considered.
For advanced or longstanding tears, sometimes a rotator cuff repair may not even be technically possible. Dr Alexander will routinely perform an MRI scan prior to considering rotator cuff surgery as there are a number of findings on this scan that can help to predict how successful rotator cuff surgery will be for your shoulder.
Sometimes rotator cuff tears can occur as the result of an acute injury. These tears are often much larger and it may be more appropriate to consider early surgical repair in these cases.
Rotator Cuff Repair
Not all rotator cuff tears require surgery, in fact many tears can be very effectively managed with physiotherapy and simple analgesia. If surgery is considered, there are a number of things that you should know before going ahead.
Firstly it is important to have realistic expectations of what we are trying to achieve. Unfortunately we can not recreate the shoulder you may have had at the age of 21, more often our goal is to regain comfortable and functional range of motion such that you could live your normal life and essentially ‘forget’ about your shoulder.
Secondly, surgery is only the beginning of the journey. Obtaining a successful result from rotator cuff repair requires a prolonged course of specialised rehabilitation. You will be required to wear a sling for four to six weeks to protect the repair as it begins to heal, following this the next phase of rehab will focus on regaining motion before finally starting to strengthen and recondition the shoulder once healing has started to mature. It often takes six to nine months to achieve a final result after rotator cuff surgery and it would be a lie to say that it’s not a hard slog.
Surgery involves a shoulder arthroscopy where a camera is inserted into your shoulder joint and a thorough inspection of all structures within the shoulder is carried out. The bursa above the rotator cuff tendons is resected to allow visualisation of the torn tendon and the tendon is then repaired back down to the bone with special bone anchors.
Following rotator cuff repair your arm will be placed in a sling. You will be seen by one of our hospital physiotherapists prior to being discharged so that you have a clear understanding of your rehabilitation plan. While the attached rehabilitation protocol is a good guide, your individual program will be tailored to your progress by your physiotherapist. It can take nine to twelve months to see the final result of your surgery so it is important to be committed to your rehabilitation to maximise your outcome.