Risks of Rotator Cuff Repair
What does the operation involve?
An arthroscopic rotator cuff repair is an operation designed to repair the torn rotator cuff tendons in your shoulder. It is a keyhole operation, usually performed under a general anaesthetic. It is usually done through three or four 5-10mm cuts at the back, side and front of your shoulder. The surgeon inspects the inside of your shoulder and reattaches the torn tendon the bone using ‘suture anchors’. These are essentially plastic screws with stitches attached. They are screwed into the bone and the stitches are used to tie the tendon back into place. Often, your surgeon will shave off a little bit of excess bone that can damage the tendon at the same time. The operation is usually performed as a daycase procedure, with 90% of people going home within hours of their surgery.
What are the risks and benefits of this operation?
The main benefit of this surgery is to relieve your shoulder pain. More than 80% of people get some benefit from this operation and many of those are largely pain-free after the recovery period. The risks are in line with the general risks of keyhole shoulder surgery, which you can find more about here.
There are also some specific risks of rotator cuff repairs, which are shown in the video above. These risks include:
- Failure of the tendon to heal or retear: Having already torn, it is an indication that your tendon is not completely healthy. Sometimes, this means that despite best efforts, it does not heal and tears again soon after surgery. Depending on the size of your tear, the risk is between 10% and 50%, with larger tears being more likely to retear. Even if your tendon does heal, it is possible for it to tear again in the future. If a retear occurs, this can result in a worsening of pain in your shoulder. However, there is still good evidence that your shoulder pain will still improve even if the tendon does not heal.
- Biceps bulge or cramps: As part of the operation, your surgeon may release the biceps tendon from inside the joint if it looks unhealthy or is causing problems. If this occurs, you may notice the biceps muscle bulging at the front of your arm. Sometimes, this is referred to as the Popeye sign. It is usually quite harmless and, apart from the change in appearance of your arm, you are unlikely to notice and decrease in strength. Some people feel a cramping sensation in the muscle for several months after surgery as the biceps settles in its new position. This usually settles over time with some massage and stretching exercises given to you by your physiotherapist.
What is the recovery after this surgery?
You will be provided with a sling after surgery, along with instructions from the physiotherapist about how to put on and take off the sling. You may be advised to use the sling for only a few days, or up to four weeks. Most people have little or no pain immediately after surgery due to the nerve block that the anaesthetist puts in. It is vitally important that you start taking painkillers supplied to you before the nerve block wears off so that you keep on top of any pain when the block wears off. Some people also find an ice pack helpful in the first few days. You may also find it more comfortable to sleep slightly propped up. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.
Your physiotherapist will give you some exercises to start. It is important that you do these exercises to prevent stiffness and maximise your chance of a good recovery. Most people are allowed to use their shoulder straight away, within the limits of pain. You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK. You will notice your shoulder improving over the next few weeks, but it can take several months of work with your physiotherapist to get the full benefit of surgery.
Returning to Normal Activities
You can do most general daily activities as you feel comfortable, such as washing and dressing. Try to keep your dressings clean and dry for the first 10 days, and if they do get wet, dry the area and replace them immediately.
When can I drive?
Most people can return to driving after around 6 weeks or when they feel comfortable. You must not wear a sling to drive.
When can I return to work?
This depends on how heavy your work is. If you work at a desk, this can be as soon as you feel comfortable, perhaps after 2-4 weeks. For heavier jobs, it will take longer. Heavy lifting should be avoided for 3 months. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.
When can I return to sport?
Some sports put more strain on your shoulder than others. Most people return to light exercise in 6 weeks and can then slowly build up to normal activity from there. It is not advisable to return to heavier exercise, overhead sports or contact sports for around 6 months. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.