arthroscopic, reconstructive & arthroplasty surgery
Arthroscopic Rotator Cuff Repair
Rotator cuff repair
Don’t Despair, Repair
The Rotator cuff is the group of four tendons in the shoulder joint providing support and enabling wider range of motion. Injury or “wear and tear” to the tendons may result in a tear, this condition is called a Rotator Cuff Tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals. Rotator Cuff Tears are often associated with other shoulder problems such as Biceps Tendon Pathology, Subacromial Impingement and AC joint Osteoarthiritis.
Rotator Cuff Tear
Rotator Cuff Tears can occur from a traumatic injury to your shoulder or from “wear and tear”. As we get older the quality of our tendons diminishes and become more predisposed to tearing. The Rotator Cuff tendons most commonly tear off their bone insertion.
The degenerative tears are often caused my “shoulder impingement” where the tendon is crushed by the overlying part of the shoulder blade, the acromion. The traumatic tears result from forceful tearing of the tendon off the bone. For example from a fall.
Symptoms
Like many conditions there is a spectrum of severity. The symptoms are similar.
Rotator Cuff Tears usually cause pain and weakness. This can vary from a complete inability to lift your arm to subtle weakness only noticed on testing. Similarly, the pain can vary from severe constant pain to pain only with particular movements and positions.
The pain is usually localised to the side or the front of the shoulder.
Diagnosis
Diagnosis is usually based on your symptoms and a thorough examination. Rotator Cuff Tears are often associated with other shoulder problems such as: Biceps tendon pathology, Subacromial Impingement & AC joint Osteoarthritis.
We would then usually obtain an MRI of your shoulder to confirm our diagnosis and provide more detail about the tear. Rotator Cuff Tears are best viewed on an MRI scan and provide exquisite detail including the location, size and chronicity of the Rotator Cuff Tear.
Treatment
Rotator Cuff Tears can vary in size and location. This will dictate treatment. Most small to medium tears can be treated non operatively first, these are rarely time sensitive. But large or massive rotator cuff tears often require surgery and are time sensitive. If a large of massive tear is not repaired within 3 - 6 months the tendons will retract and the muscle will waste away leaving it potentially irreparable.
Non Operative treatment of rotator cuff tears is multimodal. It involves:
Analgesia- simple analgesia, NSAIDs and often a corticosteroid injection
Physiotherapy- focused on movement and strengthening of your shoulder muscles and rotator cuff
It may take a few months to see benefit from non operative treatment. Failure to improve or for large size tears will require a Rotator Cuff Repair.
Arthroscopic Rotator Cuff Repair
If you require a rotator cuff repair, Dr Nandapalan will perform this Arthroscopically (keyhole). The surgery involves using a series of bone anchors and tape to anchor the tendon back down to its bone insertion. In doing so the “footprint” of the Rotator Cuff tendon is re-established. While the tendon is anchored to the bone your body will heal the tear over the following 3 months. During the surgery other associated problems such as the following will also be addressed:
Bursitis
Subacromial impingement
Biceps tendon pathology
AC joint arthritis
The surgery will usually take 30-60mins. It can be performed as day surgery or with an overnight stay. Post-operatively you will be in a sling for 4-6 weeks depending on the size of your rotator cuff tear during which time you will commence Physiotherapy and follow Dr Nandapalan protocol. Once again depending on the size of the tear your shoulder with take 3-6 months to recover.
