You have been placed on the waiting list for a repair of your rotator cuff. This leaflet aims to inform you what to expect when you are admitted for surgery and what will happen afterwards.
Rotator cuff tendon tears
Rotator cuff tendon tears occur with increasing frequency after the age of 40. Tears are not always painful and may not necessarily limit function of the arm, but when there is pain and loss of function, surgical repair may be offered to attempt to improve this.
Some patients are recommended to undergo repair in order to avoid the complications of the tear growing bigger with time. Some people experience an improvement to their symptoms following a course of physiotherapy and surgery may not always be required.
Surgery
You will be admitted to hospital on the day of surgery. You will have been pre-assessed and have undergone various tests such as x-rays, heart tracings and blood tests. On the day of surgery you will be seen by nurses, doctors and by physiotherapists.
Relatives/friends may stay for 10 minutes while you book in at the theatre reception area on ward C3. Nurses will then help you get prepared for surgery, and you will meet the anaesthetist.
The operation is performed with the shoulder numbed by a nerve block, and usually with a light general anaesthetic, so you are asleep. The operation lasts about 60 minutes, but you will also need some time to recover from the anaesthetic.
When you wake up your arm will be supported in a poly sling attached by velcro fastenings. It is important that you only remove this as and when instructed.
If you have pain, you should make staff aware so that painkillers can be provided. If the operation has been carried out using a camera, your shoulder may be swollen and blood stained fluid can leak from the wound.
This is normal and usually stops within 24 hours. If leakage persists please contact the ward.
After surgery
You will be allowed home either on the day of surgery, or the day after. Your poly sling is an aid to provide relative rest in the early stages and you will be using the sling for between 2 to 6 weeks dependent on your surgeon’s recommendation.
Early mobilisation is encouraged within safe parameters and you will be guided through the specifics by your physiotherapist and surgeon. An evidence-based guideline has been agreed upon to support your recovery and ensure appropriate, graded return to activity which starts from day one. It is important to follow advice on any restrictions you are advised on, to protect the repair while it is healing and to prevent failure of the repair. The aim of the exercises is to prevent the shoulder getting stiff and to promote healing and repair of the tendon.
You may remove the sling to wash and dress, and to regularly exercise your shoulder elbow wrist and hand to prevent stiffness developing in these joints.
You will be advised on discharge by the physiotherapy team what exercises you should start performing at home as your rehabilitation process begins.
To avoid putting stress on the repair, you should not lift your arm independently in the early stages. To gain access to the area under your arm for axillary hygiene, lean forwards and let your arm hang down.
Discomfort is to be expected following rotator cuff repair surgery. This should gradually improve in time, however this may be present to some extent for over a year. We would encourage you not to force any movement or try to push through your pain barrier, work with your outpatient physiotherapist and surgeon to establish the optimum approach.
Despite the surgical repair, we know that some of the tendons repaired retear or fail. Fortunately this often does not negatively affect the outcome. It is difficult to predict final outcome of surgery. Improvements can continue for and exceed a year following surgery.
Possible complications
All operations carry the risk of blood clots in the legs and chest, infections and problems relating to any medical condition that affected you before surgery. The most common complication of rotator cuff repair is failure to heal, despite surgery and prolonged rehabilitation.
Continuing pain can affect 15-20% of people. Infections are rare, occurring in approximately 1% of cases.
A frozen shoulder can develop giving painful stiffness for many months, though again this is fortunately rare at 1-2%. Most patients still have some discomfort with activity and in cold weather, improving to two years. The range of movement regained after surgery is unpredictable but it would be rare (though not impossible) for you to have less movement after than before surgery. Strength in the arm should improve but not reach the tensile strength of the tendon before the rotator cuff tear developed.
Follow up
Patients are normally reviewed at about three weeks after surgery. However, if there is a problem, or if you have any queries or concerns, this can usually be settled by telephoning nurses on the ward. Alternatively an earlier clinic review can be provided.
Long term
It has already been mentioned that rotator cuff tears develop naturally with age and surgery does nothing to slow this ageing process. Your repaired tendon will become thinner with time and eventually a hole may reappear. Fortunately this tends not to cause acute pain. You may notice occasional episodes of discomfort in your shoulder (or your opposite shoulder) as you get older. Further investigation and treatment is only required for severe pain or sudden changes in function.
Useful contact numbers
If you have any concerns regarding surgery, please ring for advice:
