The rotator cuff is a group of muscles closely wrapped around the shoulder. They work to keep the ball centred in the socket when we move our shoulder. The muscles can be torn through general wear and tear or after an accident/ fall. If one or more muscles are torn, the movement of the shoulder is no longer smoothly controlled. As a result the shoulder may become weak and painful.

Mode of Injury

Mostly this is a result of chronic wear and tear or overuse. Sometimes this can happen after a heavy fall or injury directly to the shoulder. It is quite common in the elderly population and does not always need repair. The decision for surgery is based on clinical findings. If you suffer from persistent pain and weakness, you need to have it repaired.

Investigations

Being a tendon, the rotator cuff cannot be seen on standard X rays which is normal most of the times. The tear can be diagnosed on clinical examination and confirmed by MRI scan or Ultrasound scan.

Treatment

A full thickness tear in young or middle-aged patients should be repaired to prevent future problems. In older age group decision is taken on individual basis depending on clinical examination and other factors.

What is the procedure and what does it involve?

The operation is usually done by keyhole surgery (Arthroscopy).

Most people are given a General Anaesthetic (you will be asleep). Some people will also have an Interscalene nerve block which will numb the arm and may last for 12-24 hours. This is to help with pain relief following your surgery.

A few 5mm puncture wounds are made around the shoulder to allow entry of the surgical instruments, one of which is a camera. The aim of the surgery is to repair the torn tendon. During the operation further damage may be identified within the shoulder that needs addressing. As the strength of the repair and the size of the tear can vary between patients, recovery period will also vary accordingly.

What are the potential benefits of the procedure?

  • To improve your pain.
  • To improve your shoulder movement and the function of your arm.

What are the risks of the procedure?

All operations involve an element of risks that include infection, stiffness, bleeding or nerve injury. However these complications comprise less than 10% taken together. In large tears or poor tissue quality, there is a re tear rate of upto 20%

Frequently asked questions

Will it be painful?

Although the operation is to relieve pain, it may be several weeks before you feel the benefit. You may have a nerve block- Interscalene Block (ISB), which will numb the arm and may last for 12-24 hours. This is to help with pain relief following your surgery.

This will mean you will wake up with a numb arm. This will wear off after 12-24 hours.
Following the operation, it is important that you take your pain medication regularly to keep the pain under control. This will help you to be able to do the exercises that the physiotherapist will provide you. You will be discharged from the ward with medication appropriate to your needs. You will be given one week’s supply. If you need further medication please book an appointment with your GP

The amount of pain you experience will vary from patient to patient, therefore take the amount of pain relief you need. This can be discussed with your GP if needed.

Do I need to wear a sling?

You will need to wear a sling for up to 4 weeks initially post-surgery. This is to protect the repair that you have had done in the initial phase of healing. It is also for your comfort. The sling needs to be worn all of the time, except for washing, dressing and doing your physiotherapy exercise.

Sleeping- Keep your sling on when you are sleeping until you are advised to remove it. For the first few weeks- you may find it more comfortable to sleep on your back initially, with a pillow under your operated arm for support. This will support your arm so that it doesn’t fall backwards. You may also find it more comfortable to sleep in a semi-sitting position. Your Physiotherapist will discuss this with you.

When can I go home from hospital?

The majority of patients go home on the same day.

When can I return to work?

You can return to sedentary jobs after 2 weeks as you feel able. For more manual jobs you should wait until after 12 weeks following your surgery, this should be guided by your Consultant.

Do I need to do exercises?

Yes, you will be given exercises and should be supervised by a Physiotherapist. The aim of these is to stop your shoulder stiffening up.
Here is a video of the procedure – please contact using the details on this website to book a consultation if you think you may have a cuff tear.