Rotator Cuff Repair Surgery
What is the Rotator Cuff?
The rotator cuff is a collective term for the tendons which attach to the shoulder and control rotation and elevation of the arm. There are four rotator cuff tendons which attach muscles from the shoulder blade (scapula) to the upper arm bone (humerus). One or more of these tendons can tear from a sudden injury such as a fall, tackle in sport, or reaching out to grab something to prevent a fall. The tendons can also tear as a result of degeneration with age. Find out more about rotator cuff tears in this article.
The symptoms of a rotator cuff tear include:
· Weakness of the arm
· Loss of range of motion and stiffness
· Impaired function of the arm, especially overhead movements
If non-operative management is unsuccessful or in more active patients, Dr Yu may recommend a rotator cuff repair.
What’s involved in Rotator Cuff Repair surgery?
A rotator cuff repair is performed in combination with a shoulder arthroscopy, which involves 3-4 keyhole cuts around the shoulder. Through these small incisions, Dr Yu will use an arthroscopic camera and keyhole instruments within the shoulder joint to assess the rotator cuff tendon.
The cartilage of the shoulder, bursa, bone spurs and labrum will also be treated if needed. This includes trimming bone spurs which can abrade the rotator cuff tendon, debriding an inflamed bursa, and removing loose flaps of torn cartilage and labrum.
The torn rotator cuff tendon is repaired via this keyhole (arthroscopic) technique. Occasionally a small 3-4cm incision is made on the side of the shoulder in order to achieve a strong repair, known as the ‘mini-open’ technique.
The tendon is repaired by grasping the torn end with surgical suture and reinserting it onto the bone of the humerus where it has been torn from. This is achieved by inserting surgical anchors into the bone.
Depending on the tendon and muscle quality, a repair may not be possible. If this is the case, Dr Yu will discuss the options with you. Surgical techniques including superior capsular reconstruction, patch augmentation and tendon transfers can be explored, and will be discussed with you preoperatively.
As with any surgical procedure, there is a small risk of:
- Wound healing problems – very unlikely with keyhole incisions
- Cardiovascular risks – stroke, heart attack, blood clots
- Swelling of the operated limb – generally subsides within weeks to months.
- Pain – discomfort is expected after an operation, however pain medications are used in a routine manner to relieve this post-operative discomfort
Specific risks of rotator cuff repair:
- Damage to nerves around the shoulder
- Stiffness or ‘frozen shoulder’
- Failure of tendon healing
What happens after the surgery?
Postoperative instructions and follow up
- Immediate post-op
After your operation you will be taken to the recovery room of the hospital, and allowed to have something to drink. When the team is happy the anaesthetic has worn off, you will be transferred to the day surgery area or to your inpatient room depending on whether you will be staying overnight. A sling / shoulder immobiliser would have been placed on your arm in the operating room, and should keep your arm comfortable and safe. If a nerve block has been performed by our anaesthetist, then your arm should feel comfortable but numb for up to 24-36 hours after the operation. When pins-and-needles are felt in the hand and arm then the block is starting to wear off, and your nursing staff will commence pain medication to keep you comfortable.
- Discharge from hospital
On discharge from hospital you will be given:
- Physiotherapy – instructions on exercises that should commence for the shoulder, elbow and wrist.
- Sling – instructions on the use of your sling, including whether it is allowed to be removed.
- Dressings – please keep dressings dry and do not remove them.
- Follow up appointment time
- Follow up
A follow up appointment will have been made for you after the operation. This will typically be an appointment around the 2-3 weeks after the surgery. If you have any concerns before this appointment, call Dr Yu’s clinic on (08) 7099 0188 to speak with us.
- Medication review – As part of your preoperative assessment, your current regular medications will be reviewed. This includes over-the-counter medications as well as supplements eg. Fish oil and glucosamine. You will be able to continue taking the majority of your regular medications, however some medications may be temporarily ceased. These are usually blood-thinning medicines (anti-coagulants) including (but not limited to) aspirin, warfarin, clopidogrel, apixaban. Diabetes medications including tablets and injections can usually be safely continued until the morning of the surgery. We will advise you when to stop taking these medications before the operation, and when to restart them after the operation.
- Smoking – Smoking greatly impairs the blood supply to healing tissues by constricting the blood vessels, as well as creating problems with anaesthesia. If ever there was a good time to quit smoking, it is before an operation and during the recovery period. You will be advised of options to help ceasing smoking during this period, and ideally beyond.
- Fasting – No solid food (including drinks containing milk) should be consumed within 6 hours before surgery. Clear fluids (such as cordial and water) may be consumed up to 3 hours before surgery, and then nothing should be taken from then (this includes chewing gum). An exception is made for regular oral medications, which can be taken with a small sip of water.
- Cardiovascular fitness – An operation most often requires general anaesthesia (meaning you are put to sleep and breathing is assisted). Dr Yu and his anaesthetic team endeavour to make your anaesthetic as safe as possible by ensuring your heart and lungs are in optimal health. This may mean a pre-anaesthetic review by our anaesthetist involving a cardiovascular assessment, with blood tests and heart tracings performed.
- Skin preparation – You should not shave or wax skin around the surgical area, as this can irritate the skin or cause superficial infections. Please advise us if you notice any skin lesions or abrasions around the operative area in the days before your surgery. Whilst waiting for your operation on the day of surgery, we will prepare the skin with antiseptic, and the operative limb will be marked.
- Illness / colds – Please advise us if you have a cold or flu-like symptoms, or urinary-tract infections. Your surgery may need to be postponed while you recover from these infections. This is to ensure your surgery is performed as safely as possible for you.
- Imaging – Please bring all relevant imaging with you to hospital (eg. X-rays / CT scans / MRI scans).
- Arrival to hospital – Please present to the hospital surgical admissions area at least 2 hours before your planned surgery, or as advised by the hospital admission staff. If you are planned for an overnight admission to hospital following the operation, please bring your regular medications with you.
Do you have a shoulder problem?
Contact our team to find out more.