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Arthroscopic Subacromial Decompression / Rotator Cuff Repair
What causes the Rotator Cuff to tear?
The rotator cuff tendons have areas of very low blood supply. The more blood supply a tissue has, the better and faster it can repair and maintain itself. The areas of poor blood supply in the rotator cuff make these tendons especially vulnerable to degeneration from aging. This helps explain why the rotator cuff tears usually occur in areas of the tendons that had low blood supply to begin with and then were further weakened by degeneration.
This problem of degeneration may be accelerated by repeating the same types of shoulder motions. This can happen with overhand athletes, such as cricket bowlers. But even doing routine chores like cleaning mirrors, washing and waxing a car or painting can cause the rotator cuff to fatigue from overuse.
Excessive force can tear weak rotator cuff tendons. This force can come from trying to catch a heavy falling object or lifting an extremely heavy object with the arm extended. The force can also be from a fall directly on the shoulder. Sometimes injuries that tear the rotator cuff are painful, but sometimes they are not.
If a tear of the rotator cuff is diagnosed following an MRI scan, ultrasound or during the arthroscopic procedure, a repair may be carried out. This will depend on the severity of the symptoms, the health of the patient and the functional requirements.
To repair the rotator cuff, either a small incision is made 5-7cm in length, or this can be repaired arthroscopically through 3-5 puncture wounds.
Post operative Management of Rotator Cuff repair
1. Eating and drinking-when able to.
2. Post-operative pain treatment is given by means of a small catheter put into the space where the operation has taken place and through this catheter local anaesthetics are injected at intervals. This numbs the painful area and reduces the need for other analgesics and facilitates rehabilitation. Oral analgesics can be taken. The shoulder will be numb after the operation and this may extend as far as the hand. Usually this wears off by 24 hours.
3. Ice may be applied 3 times daily for 4 days or until the swelling subsides. First put a towel or cloth over the area. Place an ice pack over the towel for 15 minutes, then remove it for 5 minutes and repeat. DO NOT APPLY ICE DIRECTLY TO THE SKIN, and DO NOT LEAVE THE ICE PACK ON FOR LONGER THAN 15 MINUTES AT A TIME. If you do, there is a risk of skin necrosis (frostbite).
4. The stay in hospital will be 24 hours.
5. Exercises as per the physiotherapists instructions. The arm should be worn in a polysling for 6 weeks with only passive movements in that time.
6. Rehabilitation after rotator cuff surgery can be a slow process. Function of the shoulder may take up to 6 months to return.
7. Follow up appointment will be 2 weeks later in the shoulder clinic, where wounds will be examined, the results of the surgery discussed and the rehabilitation program explained.
Complications
- Anaesthetic risk
- Bleeding/oozing
- Infection
- Instrument breakage
- Conversion to an Open procedure
- If there is excessive damage, the rotator cuff may not be repairable
The final outcome of surgery often depends on the willingness and ability of an individual patient to work on their post-operative physiotherapy programme.
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