Shoulder rotator cuff repair

This injury tends to occur in middle-age to elderly patients. There may be a long history of shoulder pain, worse and night, and made worse with overhead activity. In most cases the initial treatment is non-operative and many cases will resolve with physiotherapy. However, in the case of complete or large tears, with significant weakness, surgical repair is often required

Pre-operative investigations may include an x-rays (to detect any bone abnormality and / or arthritis) contributing to the problem. Although ultrasound investigations are frequently performed, an MRA is more accurate for both making the diagnosis and planning surgery.

The operation is performed with the patient under a general anaesthetic in an operating theatre. In most cases it is performed as an arthroscopic or “key-hole” procedure. Modern technology has enabled the surgeon to repair the tendon, either to itself, of back to its bone attachment, using very strong suture material (finer-wire, fiber-tape, or equivalent) and “suture anchors”, without the need to perform an open operation. However, on occasions the surgeon may choose to perform the operation as “mini-open” (small incision) or “open” procedure for technical reasons, especially in revision cases.

https://www.cosm.net.au/wp-content/uploads/2018/04/Shoulder-AS-with-mini-open-cuff-repair.pdf

Following surgery the patient will be in a sling, usually with an abduction pillow, and this has to be worn 24/7, including at night, for 6 weeks.

The patient is allowed to perform active, passive and gentle resistance exercises for the elbow, forearm, wrist and hand, as long as the elbow is kept in contact with the abduction pillow.

It is impart to perform passive range of motion (ROM) exercises for the operated shoulder but no active elevation is to be performed prior to the 6 week surgical review. Scapular retraction exercises can also be performed.

At 6 weeks post surgery, the patient will be reviewed by the surgeon and is allowed to begin active ROM exercises for the shoulder, as long as they have sufficient scapular control. Patients should only work in the range within which they have good scapular control. Theraband exercises can also be introduced, with the emphasis on the strength of external rotation, while resisted elevation should only be commenced when the active ROM enables elevation beyond 90dg.

In most cases patients will be expected to be using the thickest theraband around 12 weeks post surgery and therafter free weights may be introduced. Full strengthening work may be possible around 4-5 months post surgery.