Rotator Cuff Repair Surgery

What is Rotator Cuff Repair Surgery?

A healthy shoulder is the most versatile joint in the human body.

It has a wider range of motion, able to more freely, and in more directions, than any other joint. The shoulder's versatility enables us to hammer nails, swing golf clubs, roll bowling balls, and perform thousands of other activities.

The shoulder's flexibility is due to its unique structure.

Like the hip, the shoulder is a "ball-and-socket" joint - a "ball" at the top of the upper arm bone (the humerus) fits neatly into a "socket" formed by the shoulder blade (scapula). But unlike the hip joint, where the ball sits in a deep, well-protected socket, the shoulder socket is very shallow.

The soft tissues surrounding the shoulder are most important in maintaining the stability of the shoulder. 

The rotator cuff tendons help to stabilize the shoulder joint and turn the arm outward and inward. A tear of the rotator cuff can occur to any one of these tendons making injuries to the rotator cuff one of the commonest shoulder problems, which can only be treated surgically.

 

THE PROCEDURE

In order to repair a torn rotator cuff, the surgeon reattaches the damaged tendon (or tendons) to the upper arm (humerus).

Arthroscopic surgery is a technique for performing an operation using pen-shaped instruments with a miniature video camera attached to the end. It is "keyhole" surgery. This surgery involves several key steps:

• The surgeon makes a number of small incisions in the shoulder about the size of a buttonhole.
• The camera and specialized surgical instruments are inserted into the shoulder through these small incisions and surgeon performs the operation while watching a screen
• During this operation, the surgeon removes any scar tissue and bone spurs and releases any ligaments that are pressing on the tendon. If a bursa is inflamed, the surgeon excises or removes it. The surgeon also may remove a small portion of the acromion to make sure the repaired rotator cuff has enough room to move.
• The surgeon carves a small trough at the top of the upper arm, then drills small holes through the bone.
• Finally, the surgeon sews the tendon to the bone, with the sutures going through the tiny holes in the upper arm. (Sometimes a surgeon will use permanent anchors to attach the tendon to bone.
• Rotator Cuff Repair Surgery usually takes between one to two hours, sometimes even less.
• Most rotator cuff tears can be repaired by arthroscopic surgery, however, it can sometimes be a complicated procedure, especially with very large tears, it is often combined with an open procedure.

The Rotator Cuff Repair Surgery Advantages

• Less post-operative pain
• Less time in hospital (usually can be performed as a day-case operation)
• Quicker return to work and sports
• Usually no stitches to remove
• Less wound complications

Preparation for Rotator Cuff Repair Surgery

Before your departure your records will be reviewed thoroughly by our orthopedic surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will also review your hip replacement procedure and answer any questions.

Getting your house ready before your surgery

It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

• Remove all your throw rugs or anything on the floor that may cause you to trip.
• Move phone and electrical cords close to the walls.
• Move necessary personal items you need to reach to shelves and tables that are above your waist level.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

• Loose tops which open at the front, giving easy access
• Underwear and socks
• Short robe or pajamas
• Toiletries

ROTATOR CUFF REPAIR SURERY RECOVERY

After rotator cuff surgery, the patient is taken to a recovery room for an hour or two.

The injured arm is kept in a sling, often with a pillow behind the elbow and ice is applied to the shoulder for comfort.

Patients are encouraged to get out of bed with the arm in a sling. The sling can usually be released but not removed, allowing the elbow to straighten without moving the shoulder.

 Patients who had arthroscopic surgery are often allowed to return home on the same day.

With time, healing occurs, as scar tissue connects the tendon to bone. Because tendons receive such poor blood supply, this is a slow process.

Physical Therapy

Physical therapy plays an extremely important role in the Rotator Cuff recovery process. A physical therapist teaches the patient exercises designed to help regain flexibility and strength in the injured shoulder.

Most patients begin physical therapy before leaving the hospital. The physical therapist is an educator. The therapist’s role is to teach the patient appropriate exercises that can be done safely at home to speed the recovery from Rotator Cuff Surgery. He or she will also teach the patient how to avoid re-injuring the surgically repaired rotator cuff.

Because physical therapy can be difficult and physically demanding, our therapists usually like to meet with members of the patient’s family in the hospital so they can learn to help the patient with physical therapy at home.

Home Instructions

At home, it is extremely important to perform physical therapy exercises as directed, usually five times a day.

Patients should begin moving the shoulder through its full range of motion as soon as possible after surgery in order to prevent the formation of scar tissue. This is performed passively, or with the use of the opposite arm to assist. If the shoulder is not moved properly, scarring may cause it to stiffen. Stiffness may cause discomfort and limit the ability of the shoulder to function. Ice should be applied to the shoulder after exercising.

Patients often notice some skin discoloration near the wound or in the upper arm. There’s no need to worry. The hand or forearm may also swell. Usually this swelling will go down if the arm is elevated appropriately.

The First Twelve Weeks After Surgery

During the first twelve weeks after surgery, it’s important to follow two basic principles:

• Perform physical therapy exercises regularly. Moving the surgically repaired arm through its full range of motion is crucial to prevent scarring and stiffness.
• Strictly control activity when not exercising. Be extremely careful not to lift the surgically repaired arm away from the body. Don’t use it to push or pull anything.
• The arm should always be kept in the sling when you are standing or walking. When sitting or lying awake in bed, you can release the sling without removing it.
• The sling should be worn at night until satisfactory control of the arm is regained. Remove the sling only to exercise or take a shower.
• The injured arm should be used only for exercise. It is okay to use the hand for writing, eating, or drinking, as long as the arm is moved only at the elbow and wrist.
• Under no circumstances should the injured arm be used to reach for or lift something. It should not be lifted above the head or moved away from the body.
• Driving after rotator cuff surgery is to be avoided for at least six weeks, or until the sling is discontinued.  Driving with one arm is unsafe, and the surgically repaired arm shouldn’t be moved away from the body. It’s also easy to re-injure the shoulder in an accident or an emergency stop