Rotator cuff tear and shoulder arthroscopy
Rotator cuff tears are injuries which occur in the large group of muscles and tendons responsible for the shoulder’s motion.
Four major muscles comprise this structure: the supraspinatus, infraspinatus, teres minor, and subscapularis. Of these, the supraspinatus tendon is the most commonly torn.
While typically caused by high-impact injuries in younger patients, rotator cuff tears can also develop from general wear-and-tear with no history of trauma. This is particularly common in patients over age 60.
Treatment for rotator cuff tears
Not all rotator cuff injuries require repair. Patients who are less active, do not require full shoulder strength and stability, or have partial thickness tears may recover with conservative treatment only.
This typically involves activity modification to avoid exerting the site of injury, pain management using non-steroidal anti-inflammatory medications (NSAIDs), and physiotherapy to increase joint stability by strengthening the deltoid muscle. Corticosteroid injections are sometimes employed for pain relief, although this brings of decreased tendon quality if surgical repair is required later on.
Painful tears which are not treated surgically become 25 to 50% larger within 3-4 years. As the tendons do not regrow or reattach on their own, surgery is usually required to manage full-thickness and partial-thickness tears which do not respond to conservative treatments.
Rotator cuff repair surgery
The goal of rotator cuff repair surgery is to restore strength and range of motion to the shoulder joint by re-joining damaged tendons.
As the tendons in the rotator cuff tend to tear away at the point they meet the bone, surgical rotator cuff repair generally involves placing anchors into the bone and securing the torn tendon with non-dissolving sutures.
If the tendon is torn further along its length, surgical repair may instead involve retrieving the retracted end and suturing it back to the attached portion. As torn tendons tend to tighten and retract over time, tendon grafts may be employed if repair occurs some months after a full-thickness tear.
Dr Jonathan Cabot has undergone extensive training to provide this surgery with a minimally-invasive, arthroscopic approach. Specialised small tools are passed several small incisions and used to conduct the procedure with minimal disruption to the surrounding tissue.
Indications for surgery
Younger patients who have good quality muscle tend to respond best with surgery.
Large or complex tears may not be easily reached with an arthroscopic approach and may require open surgical intervention. This allows the surgeon to better access the operative area and fully repair the torn tendon.
If the tendons are chronically retracted into the shoulder or the rotator cuff muscles are very weak, the site may not be receptive to repair. Patients with arthritis in the glenohumeral (shoulder) joint are also best managed with other approaches, as a lack of suitable bone structure can impact long-term outcomes.
As with any case, Dr Jonathan Cabot approaches rotator cuff repair on an individual basis. Any treatments – surgical or otherwise – will be discussed and assessed for suitability at your consultation appointment.
Recovering from surgery
After surgery, you will wake up with your arm immobilised in a sling. The shoulder is numbed with a local anaesthetic which will wear off over time.
Most patients are able to leave the hospital on the same day as the surgery, and patients who undergo arthroscopic repair generally experience less post-operative pain and a faster return to activity than patients who receive an open approach.
Recovery is highly variable, and your arm may remain immobilised for 2-8 weeks after surgery. You will not be able to drive during this time period. Physiotherapy to strengthen the deltoid muscles is commenced during this period.