What Is Shoulder Tendon Repair (Rotator Cuff Surgery)?
Shoulder tendon repair surgery (also known as rotator cuff Surgery or shoulder surgery) is required for the repair of tears or inflammatory conditions of the rotator cuff tendons of the shoulder. The surgery is most often employed when the patient’s shoulder has not responded favorably to more conservative measures (like medication). Comprised of four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) and their tendons, the rotary cuff is responsible for raising and rotating the arm.
Rotator cuff injuries are common in people who repetitively and forcibly lift their hands overhead. Athletes who engage in baseball, tennis, cricket, weight lifting, and rowing are unusually susceptible; especially when they are 40+ years old. However, younger people may sustain shoulder tendon complications following acute trauma or injury.
A torn shoulder tendon is usually characterized by pain, restriction of movements, atrophy of muscles near the shoulder, and crepitation (crackling sounds) while moving the shoulder in certain planes. Doctors usually diagnose the condition using clinical and imaging tests such as X-Rays, USG, and MRI scans. Depending upon the nature of the injury, the operation can either be an arthroscopic repair or an open surgical repair.
The general principle around shoulder tendon repair is to re-establish the anatomic continuity of the tendon system, relieve pain, restore full range of movement and improve the strength of the shoulder (although this may not be achieved to the extent of the pre-surgery state). Ordinarily, general anesthesia is given, though nerve blocks may also be used.
In the arthroscopic approach, a buttonhole incision is made near the shoulder through which an arthroscope (a pencil shaped instrument) is introduced allowing the surgeon to see the inner-workings of the joint on a monitor. Through 1-3 more incisions, other special instruments are inserted to remove the dead parts of the torn tendon, the damaged bursa, and other tissue debris (debridement). In addition, the surgeon will use these openings to shave off any bony spurs that might impinge on the repaired tendon system and damage it (subachromial smoothening) and repair the damaged tendon at its thickest and healthiest portions using absorbable sutures. Sometimes metal rivets may be used to secure the sutures. They also do not need to be taken out after surgical repair.
In cases where the arthroscopic approach is not advisable (e.g. large tears) or has failed to provide adequate success, the physician might opt for open surgery. The surgeon gains access through a much larger incision. Due to the more invasive nature of open surgery, patients typically require longer rehabilitation and recovery periods. The actual procedure itself typically takes 1-3 hours.
After surgery, the patient undergoes monitoring, during which he or she might receive antibiotics to prevent infection and ice packs to regulate swelling. Incisions from arthroscopic rotator cuff repair heal within a few days, while incisions open surgery tends to last considerably longer, with stitches staying in for 10-12 days.
The patient is generally unable to drive or do light lifting for 1-3 months following surgery. Heavy manual work and sports might be delayed for 8-12 months depending on the patient.
Patients typically undergo physiotherapy and periodic orthopedic check-ups during the lengthy rehabilitation process. Following a successful operation, pain diminishes and full range returns. However, patients shouldn’t necessarily expect to achieve the same strength and stability that they had prior to the condition. Stiffness and weakness are not uncommon.
Complications from shoulder surgery are usually minimal. They may include common anesthetic adverse effects, hemorrhaging, infection (mostly superficial infections, though deep infections may set in weeks after the procedure), recurrent tears, reflex sympathetic dystrophy, pain, and stiffness of the joint. However, the risks of not undergoing rotator cuff repair surgery include rotator cuff tear arthropathy—a condition characterized by progressive loss of function, severe arthritis, pain, and permanent loss of flexibility.