The rotator cuff consists of 4 muscles with their tendons attaching to the humeral head. They are the supraspinatus, infraspinatus, subscapularis and teres minor.
These tendons centralize the relatively large ball in a small socket and assist in providing stability to the shoulder joint. When one or more of these tendons is damaged the shoulder can become painful and weak. In many cases the affected shoulder also becomes stiff.
Most commonly the supraspinatus tendon at the top of the shoulder is involved but other tendons may also become torn. Partial thickness tears can be treated with simple pain medication and physiotherapy but there is a risk of the tear progressing to involve the full thickness of the tendon. Full-thickness symptomatic tears usually require surgical repair.
Acute traumatic tears commonly occur in younger patients where the tendon quality is usually sufficient to allow solid re-attachment and full recovery after surgery.
In patients who have a longstanding large tear the quality of the tendon can become so poor that an adequate repair is not possible. The torn tendon can also cause the muscle to shrink to such an extent that it is not functional any more and the tendon may be retracted so much that it is not amenable to repair. In these cases partial repair may be beneficial in providing adequate pain relief.
We perform most of our cuff surgery through keyhole surgery (arthroscopy). The benefits of this technique include faster early recovery and a better cosmetic result.
Surgery is performed under a general anaesthetic with a nerve-block to reduce post-operative pain. Patients usually are in hospital overnight and return home the day after surgery. A shoulder sling is used for four to six weeks and a gentle physiotherapy program is started to prevent stiffness and help regain shoulder function.