If conservative treatment fails to relieve the symptoms of a rotator cuff tear, then surgical repair of the rotator cuff may be required. This is particularly the case if the pain is severe and/or waking the patient at night and if the patient is unable to return to their normal employment or major leisure activity. There are a number of surgical approaches that can be used and include the following.
This is applicable for small tears in the rotator cuff tendon and involves the use of a fibreoptic telescope placed into the shoulder and combined with several small incisions allows access to the torn tendon enabling repair. Arthroscopic removal of the acromial spur (acromioplasty) can be performed at the same time. This spur often contributes to the tear by rubbing on the tendon close to its attachment to the upper humerus (arm bone). The advantage of this procedure is that it allows for a quicker recovery than occurs with open methods.
Mini Open Repair
An arthroscopic acromioplasty combined with a small incision to repair the torn tendon is applicable for medium to large full thickness tears of the rotator cuff. The majority of tears can be treated with this technique.
Most tears are located where the rotator cuff tendon attaches to the top of the arm bone (humerus). Special bone anchors with sutures are used to reattach the tendon onto bone at this location.
Open Surgical Repair
A fully open repair is sometimes performed where the tear is massive. It involves making a large split in the deltoid muscle to achieve sufficient exposure to repair the torn tendons. It often requires a longer rehabilitation period to allow healing of not only the rotator cuff tear, but also of the deltoid muscle.
The decision to use the different approaches will depend on many factors, but are largely related to the size of the rotator cuff tear.
Most patients will be discharged with the arm in a sling on the first postoperative day and they will be given some simple exercises to do at home. The patient will be reviewed in the consulting rooms at 2 weeks post surgery to remove sutures, and once again be given further exercises.
In the majority of cases patients are sent for a course of physiotherapy. It is important during the first 6 weeks that active elevation and abduction (movement of the arm away from the side of the body) is avoided. It takes at least 12 weeks for the rotator cuff tendon to heal back to the bone. If active movements are commenced prematurely then there is a much higher chance that the rotator cuff tendon will not heal.
It is usual for patients to take several months to recover from rotator cuff surgery. It is quite common to have significant stiffness and some degree of pain for 2 to 3 months after surgery, however most patients consider the surgery to be very successful in the long run in relieving their pain and weakness.