Rotator cuff repair
The rotator cuff refers to a group of tendons and muscles in the shoulder that hold the shoulder ball (head of humerus) firmly in the joint. If you didn't have a rotator cuff, your shoulder would just keep on dislocating, with the humeral head dropping out of the socket; a bit like a golf ball dropping repeatedly off the tee.
The rotator cuff holds the joint in position so that the larger muscles can move the shoulder around as needed. If the rotator cuff is damaged, it can cause weakness and pain when moving the arm as the other muscles have to compensate.
Rotator cuff tears become more common as we age. As we get older, our muscles can start to tear, causing instability in the joint. We may notice this first as pain, weakness and the shoulder getting tired very quickly.
As the joint moves abnormally (or “wobbles”), it gets sore. Depending on the size and extent of the rotator cuff tear, the pain you feel may be reasonably mild or severe. Over time, pain in the shoulder can slowly translate to weakness, itself leading to loss of movement in the shoulder and possible arthritis.
Rotator cuff repair surgery is an operation to fix the problem and to get you out of pain.
Smaller tears are easier to fix and have a better outcome than bigger tears, small tears can get bigger with time, so earlier treatment is more effective.
When I see you for a consultation, I will examine your shoulder and carefully move your arm into various positions to help me assess the severity of the problem. I will also usually arrange for you to have an X-ray and ultrasound scan of the shoulder as these are really good ways of identifying rotator cuff tears.
This consultation is also your chance to ask any questions and raise any concerns you may have. Nobody knows the pain and discomfort you are experiencing better than you, and it is important you tell me the different ways it is affecting you so that I can ensure any treatment options I advise are right for you.
As a shoulder specialist, many of the conditions I treat are a result of trauma or injury to the shoulder. Rotator cuff tears are no different, although they can also occur as a result of the aging process.
There are non-surgical treatment options to help manage the pain and a surgical repair option if needed for more painful or extensive tears.
Not all tears will need to be repaired. Some people can compensate and are very happy with their shoulder despite having a tear. Others will struggle and need further treatment. Physiotherapy can be really helpful, although people do sometimes find it is quite painful. We can work with your physiotherapist or our Circle physiotherapists will be able to show you suitable exercises.
Painkillers, such as paracetamol, taken when needed can often help to manage the pain well.
When I think it would be helpful, I may advise you to consider a corticosteroid injection into the shoulder. This often relieves the pain significantly and the effects can last a reasonable time. Often, this period of relief allows you to really work with the physiotherapists to build up the rest of the shoulder muscles.
If you're still struggling with pain or loss of movement, I can carry out a special type of surgery known as arthroscopy to help repair the tear and relieve the pain you're experiencing.
Arthroscopy is a type of keyhole surgery. Using only tiny cuts into the shoulder, I'll insert a thin tube known as an arthroscope into the joint. The arthroscope has a light and a camera and gives me a really good view of the joint. Once I have assessed the rotator cuff, I will insert small surgical tools through the arthroscope and repair the tear.
Shoulder arthroscopy will usually improve your pain, but it's important to be aware that it will take a good couple of months to fully recover from a rotator cuff repair. The operation itself is carried out as a day case procedure and you will be wearing a sling for around three weeks afterwards, but other than that, it is important to give the shoulder time to rest and fully recovery. Most people will feel maximum benefits around 6 months after the surgery, following our structured rehabilitation protocol.
I decided fairly early on in my orthopaedic training that I wanted to specialise in treating shoulder and elbow problems. During my years working as a shoulder and elbow specialist, I have been privileged to see the difference good, effective treatment makes to people's lives.
If you have pain or discomfort in your shoulder, a consultation will help us find out exactly what the problem is. Once we know the cause of your pain, we will be able to talk through treatment options so that you can make an informed decision.
It's easy to schedule an appointment with me here at Circle, my private secretary will be delighted to help you book a time and day that is convenient for you.