Rotator Cuff Repair: Indications and Complications

The shoulder joint is composed of three bones; humerus, scapula and clavicle. Theses bones are held in place with the help of ligaments. Movement at the shoulder joint is provided by muscle attached to or originating from these bones. The rotator cuff is a group of muscles which come together as tendons which cover the head of the humerus. These tendons and muscles help in lifting and rotating the arm at the shoulder joint. Tear in the tendon of the rotator cuff leads to

• Pain at rest and during motion
• Weakness of the shoulder joint
• Crackling sensation while moving the shoulder.

Tear in the rotator cuff can be caused by multiple reasons. The causes can be classified into acute and chronic.

• Acute cause
• Fall on outstretched hand
• Lifting of a heavy object.

These injuries are generally accompanied by other injuries to the shoulder

• Chronic cause
• Bone spurs
• Reduced blood supply with age
• Repetitive stress

Procedure of Rotator cuff repair

Rotator cuff repair can be performed as an outpatient or an inpatient procedure. Your surgeon will discuss the possible option with you and help you decide the best choice for you. After reaching the hospital you will be asked to change into a hospital gown. The anaesthesia team will prep you for the surgery. Rotator cuff repair can be performed under general anaesthesia (you will be unconscious throughout the procedure) , local or regional anaesthesia (the shoulder will be numbed but you will be conscious throughout the procedure). After the effect of anaesthesia set in the orthopaedic surgeon will proceed with the surgery. There are three major ways in which the surgery is performed:

• Open rotator cuff repair: the surgeon will put an incision over your shoulder and carefully dissect through the layers under the skin. The muscle covering the shoulder (deltoid) will be detached from the shoulder for better visualisation. This surgery is generally reserved for patients with large or complex tear. The surgeon can also remove bone spurs during this procedure if indicated.
• Mini open repair: this method combines technique of arthroscopy and open surgery. (arthroscopy is a method to visualise and treat conditions inside the join with the help on thin instruments which are introduced into the joint capsule) The surgeon makes an incision, the size of 5 cm over the shoulder. Arthroscopic instruments are introduced via this incision for assessing and treating damage within the joint. Following its completion the surgeon repairs the tendon through the small incision over the shoulder.
• Arthroscopic repair: an arthroscope and accompanying surgical instruments are introduced into the shoulder joint through small incisions. The tendon is repaired with the help of the introduced surgical instruments. This procedure can be performed on an outpatient basis.

Indications for Rotator cuff repair

There are multiple conditions that may cause rotator cuff tear. Your doctor will suggest you undergo rotator cuff repair when:

• You have been experiencing constant pain that hasn’t improved with medical or physical rehabilitation therapy
• Weakness caused by the tear interferes with your daily routine
• Tear is due to an acute cause
• Large tear (>3 cm).

Preparation for Rotator cuff repair

Your provider would like to record a detailer history of your complain and perform a thorough physical examination. You may also be requested to undergo a few blood and diagnostic tests to ensure that you are healthy enough to undergo a surgery. In addition your provider would like to know about all the medication that you are consuming, you may be requested to stop some of them like blood thinning medications as you prepare for the surgery. Inform your doctor if you have a history of allergy to any medications or anaesthetic agent. You will be asked to stop consuming solid food eight hours before the surgery. It is advisable to arrange for someone to drive you home from the hospital.

Complications of Rotator cuff repair

Complication experienced by patients after rotator cuff surgeries are:

• Infection at the site of surgery
• Detachment of deltoid (the muscle that was separated from the shoulder joint during open rotator cuff repair) from the humerus
• Stiffness of shoulder joint
• Development of another tear in the rotator cuff
• Injury to nerve during the surgery.

Recovery from Rotator cuff repair

After the surgery you will be continuously monitored as the effect of anaesthesia wear off. Feeling pain after the surgery is normal. Your doctor will prescribe medicines to help manage the pain. Following the surgery it is important to follow the exercise schedule to ensure smooth recovery and reduce risks of complications. You will be advised to wear a sling to ensure prevent excessive movement at the shoulder joint while the tendons heal. For the first 4-6 weeks after the surgery your therapist will help you with passive exercise; wherein your therapist will move your hand into different positions while supporting your arm. After this period you will be allowed to do the same movements on your own. Between 8-12 weeks after the surgery, your therapist will gradually introduce strength exercises into your routine. Most patients recover fully in 4-6 months.

Sources

• Rotator cuff tear, surgical treatment- AAOS
• Rotator cuff tear- AAOS
• John Hopkins medicine health library