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Rotator cuff repair surgery is a procedure that repairs torn or injured tendons in the shoulder, with the aim of restoring function and reducing pain in the affected area.
With HCA UK, you'll receive:
Rotator cuff repair surgery reattaches tendons which have torn off the ball of the shoulder at the top of the arm bone. There are many techniques and variations.
This operation is needed if the tear is the result of an injury or if the pain and weakness in the area isn’t improved with injections and physiotherapy. During the procedure, injured tendons and muscles are repaired. This may include replacing damaged parts of the tendon with a graft tendon from another part of the body. Bone spurs, if present, will be removed.
The repair is done to relieve pain and improve shoulder strength. A period of physiotherapy is required in addition to the surgery.
The shoulder joint itself is formed between the humeral head, which is the ball shape at the top of the upper arm bone, and the socket on the flat shoulder blade.
The rotator cuff is the name given to the group of four shoulder muscles and the tendons that surround the shoulder joint. Tendons are strong bands of tissue that connect muscles to bones.
In the shoulder joint, the muscles are attached to the shoulder blade and become the tendons attached to the top of the arm bone (humerus); these keep the humeral head and the glenoid stable so that the ball is centred in the socket. When you move your arm, the rotator cuff muscles contract. This stops the head of the humerus from sliding out of the socket, keeping it in place while allowing for a full range of motion and controlling those movements.
Symptoms of rotator cuff injuries
Rotator cuff tears can be categorised in various ways.
It's possible to have a partial or full tear:
It’s possible to tear some or all of the tendons:
It’s possible to tear quickly or slowly:
It’s also possible to have new and old tears:
The type of tear you have will often dictate the type of surgery your consultant recommends.
A rotator cuff tear operation is recommended if other types of treatment haven't delivered the desired results, or if surgery is the best option for your injury. Your consultant will probably initially suggest non-surgical treatments for your shoulder cuff tear, such as:
Icing the shoulder throughout the day may help to reduce pain and swelling, too.
If these treatments are unsuccessful or your pain becomes more severe, your consultant may then recommend the following:
Choosing rotator cuff surgery is a complex decision made by you and your specialist. If your pain does not improve with non-surgical methods, your doctor may offer surgery as an option for a torn rotator cuff.
Also, if you are very active and use your arms for overhead work or sports, you might need a rotator cuff operation to ensure that your shoulder can support these activities that affect the area.
Other factors that make surgery the right treatment option include:
To confirm that a rotator cuff operation will be the most effective way to treat your symptoms, your consultant will carry out a full medical assessment. They'll also ask about any activities that make the pain worse. Your consultant will assess your shoulder's range of movement, strength and stability during a physical examination.
They may recommend imaging tests such as an X-ray and an MRI scan. These can confirm the level of damage to the joint. A specialist musculoskeletal radiologist will report on the results, providing your consultant with the full picture before discussing your treatment options with you.
A rotator cuff repair involves freeing up the detached tendon and securing it back where it belongs. It then heals back to the bone over about three months. Attaching the tendon is commonly done with ‘suture anchors’, often made of dissolvable material, to hold the tendon down onto the bone. Other methods can involve permanent sutures through tunnels in the bone.
There are two types of rotator cuff operation: arthroscopic or open. What kind you have will depend on how advanced the tear is. It's likely that, whichever type of surgery you have, it will be performed under general anaesthetic, although regional anaesthetic is possible.
Arthroscopic rotator cuff repair surgery
Most rotator cuff repair operations are carried out arthroscopically. This is a minimally invasive procedure that's a form of keyhole surgery. Surgeons make small cuts around your shoulder so that they can then pass equipment that includes a small surgical camera (arthroscope) into the shoulder.
The camera projects images of the inside of your shoulder onto a monitor and your surgeon uses these images to locate the damaged part of your rotator cuff. They use specialised equipment to reattach the tendon to the upper arm bone.
Open rotator cuff repair surgery
In some cases, open surgery is required. This will be recommended if you have a large tear in your rotator cuff.
The surgeon makes an incision through the deltoid muscle to gain access to the torn tendon. Sometimes this muscle is partially detached.
Reattaching the torn tendon is just the same as the keyhole operation. Stitches or staples are used to close the skin incision.
Other variations
For partial tears a ‘trans-tendon’ repair can be carried out to reinforce the damaged part, or the tear can be completed and repaired as a normal full-thickness tear.
A thin degenerate tendon can be thickened by adding a patch of material to the repair.
Sometimes massive irreparable tears are best treated by shoulder replacement.
Your consultant will explain how the procedure works and tell you what to expect on the day of your rotator cuff repair operation and the days that follow. You can also ask any questions you have about the procedure.
It's worth taking the time before your surgery to prepare for your return home after your operation. You'll need to arrange for someone to pick you up from the hospital, as you won't be able to drive, and it's worth seeing if someone can assist you while you recover.
You should be able to go home the same day. The incision made during your operation will be covered post-surgery with a dressing. After leaving hospital, you'll be advised on ways to reduce the risk of any infection.
Any stitches or clips are usually removed after one to two weeks. We'll invite you to a clinic for a follow-up assessment around six weeks after your operation. It can take up to a year to get back enough strength in your shoulder to return to normal activities.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask your healthcare team or your consultant for advice. It's important to be aware that you may not get back the same strength that you had before you damaged your shoulder.
Functional recovery from rotator cuff repair is quite a long process with distinct phases.
First three months
The tendon takes three months to heal back to the bone. During this time you should not try to use the repair, as it is not strong enough. You need physiotherapy to help you protect the repair. The physio will also help you recovery the range of movement in your shoulder in a safe manner.
Second three months
Once the tendon is healed you can start to rebuild the muscles that have not been able to exercise for many weeks. Strength can be regained. It is important to relearn the muscle patterns with physio supervision, to avoid the complications of poor co-ordination.
Third three months
By now you should have a fairly ‘normal’ shoulder, and you can start to train for your chosen work and leisure activities
Up to and over a year
Data shows that shoulders continue to improve a little even this long after rotator cuff repair repair surgery
If you're experiencing pain in your shoulder and would like to get a medical opinion, book an appointment with one of our specialist shoulder consultants. If you have private medical insurance, you'll need a GP referral letter and a reference from your private medical insurer.
They'll request any necessary imaging tests, which can usually be carried out on the same day. All treatment routes will be discussed with you before surgery is considered. If surgery is suggested, you'll be given all the information you need to make an informed decision.
You can browse the profiles of our expert orthopaedic surgeons with vast experience of performing a private rotator cuff surgery service.
This depends on many factors including:
Your consultant can advise you. Legally you must be in complete control of the vehicle. Sensibly, start with short journeys and have someone accompany you in the car.
As with any type of surgery, there are risks to consider. These include:
The cost of private rotator cuff surgery depends on the tests and treatment you require. Payment can be made through your medical insurance provider or by yourself. If you're a self-pay patient, please ask your consultant for information on treatment prices for peace of mind.
Please get in touch for more information about pricing and the estimated cost of private rotator cuff surgery.
To discuss your shoulder pain with an orthopaedic consultant who specialises in shoulder treatments:
At HCA, we have a breadth and depth of knowledge about shoulder conditions that equips us to assist in all manner of cases. Our orthopaedic team includes expert shoulder consultants. Their experience means your care is personalised to your symptoms.
Other reasons to choose us include:
We have the experience and knowledge to diagnose the cause of your shoulder pain, provide leading treatment and support the management of your condition. If you require a torn rotator cuff operation, we'll support you with expert care. Complete our online booking form today.
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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.