Rotator cuff injuries can be very painful and debilitating. As we age, it is common to develop some degenerative change within the rotator cuff tendons. From middle age onwards, people will often develop degenerative tearing within the rotator cuff tendons. In many cases this may not be symptomatic.
If a patient suffers an injury to the shoulder, that may aggravate the underlying degenerative change within the shoulder joint or they can cause an acute tear of the rotator cuff tendon.
Most patients will have an ultrasound scan organised by their general practitioner before referral to a specialist. This may give some indication as to the integrity of the rotator cuff tendons. An MRI scan however will add a lot more detail as to the degree of injury.
Non Surgical Treatment
In cases of degenerative disease, nonoperative measures may be considered initially. These may include appropriate analgesia and a course of physiotherapy. The aim of the physiotherapy is to strengthen the remaining rotator cuff muscles. Many patients will improve over a period of time.
In cases of acute traumatic tears of the rotator cuff, consideration can be given to having a surgical repair.
Procedure
The patient undergoes a general anaesthetic. Intravenous antibiotics are administered to reduce the risk of infection. A small stab incision is made the back of the shoulder to allow the camera to be inserted to inspect the shoulder joint and the integrity of the rotator cuff tendons.
The bursa overlying the rotator cuff tendons is often thickened and inflamed. This can be removed using instruments inserted from the front or the side of the shoulder through further keyhole incisions. The undersurface of the acromion process which overlies the shoulder joint, is smoothed off using a burr.
A small mini open approach is performed on the side of the shoulder to allow the rotator cuff to be sutured back in place. Anchors are inserted into the humeral head with sutures attached. The sutures are passed through the rotator cuff tendon and the tendon is snugged into position as the sutures are tied.
Post-operative Care
Once the rotator cuff tendon has been repaired, it has to be protected whilst it heals into place. This usually involves at least a six-week period of immobilisation in a sling. Following that, the patient can start working on some gentle range of movement exercises. Strengthening exercises are usually commenced at around the 12-week stage.
It can take a long time to recover following rotator cuff tendon surgery. Often patients will still have gradual improvement in the range of movement and strength over the first 6-12 months.
In some instances, the rotator cuff tendon will be too thin or degenerated to allow a repair.