The shoulder is a ball (humeral head) and socket (glenoid). The muscles act to elevate the arm. The large outside muscle is the deltoid and deep to that is the rotator cuff – a combined tendon inserting into a prominence on the head called the greater tuberosity. Four muscles contribute to what is called the rotator cuff. In most cases, the supraspinatus muscle is torn. 3 muscles attach to the greater tuberosity; supraspinatus, teres minor and infraspinatus. 1 muscle attach to the lesser tuberosity; subscapularis.
These are fairly common, mostly due to degenerative (“wear & tear”) causes. In some, the cause may be due to impingement by the overlying acromion or injuries (falls, etc.). The tendon always tears off in the insertion site on the humerus.
Pain in the shoulder and down the outside of the upper arm, often worse at night. There may be increased pain and weakness when elevating the arm. If left untreated, the pain might subside but the weakness will increase.
Normally we would do an Arthroscopic Rotator Cuff Repair. In a number of older individuals, the tears can be asymptomatic (pain-free) – these would usually not be operated if it’s not affecting the quality of life. Tears can, however, enlarge with time, with muscle atrophy (“wasting away”) resulting in an irreparable tear. Patients who have irreparable tears would need replacement surgery later. For these patients a Reverse shoulder replacement would be done as most of these patients would be elderly. There would most likely be Osteo-arthritis present as well.
For the rotator cuff repair, we usually do this arthroscopically (“key-hole surgery”). Tiny holes (10mm) are made around the shoulder for passage of the instruments. The bone is made raw to enable the tendon to heal to it. Bone anchors (tiny devices with sutures attached) are drilled into the bone and the tendon is repaired to the bone with the sutures. Healing of the tendon to the bone takes around 6 weeks and even longer to strengthen – up to 12 months. A Reverse Shoulder replacement is an open procedure where we remove part of the humerus and place prosthesis in the shoulder.
You can usually go home the next day. You will wear a sling for 6 weeks to protect the repair. During this time you will not be allowed to do active movements of the arm. After 6 weeks the patient will start with physiotherapy. Initially only movement is regained. Only when movement is regained fully is strengthening of the shoulder muscles allowed.
You will have pain for a few days, for the first day or two it will be controlled with the nerve block, then with painkillers. For most people the pain is only moderate after the arthroscopic repair.
Prognosis (Success rate) > 90% of patients become pain-free with normal function after a few months.
Infections are very scarce and more frequent in patients that undergo open surgery rather than arthroscopic surgery. This should be treated by antibiotics and drainage and lavage of the joints if necessary.
This complication is difficult to treat. In my practice I do an arthroscopic capsulotomy for patients that still have stiffness at 12 weeks post-operative. After a Capsulotomy, patients will receive physiotherapy and start to mobilise the shoulder immediately. Some patients require a Manipulation after the Capsulotomy as well.