Rotator Cuff Injury Repair

September 17, 2017 | Focus Surgery

What you need to know about recovery from a rotator cuff injury

As a focused shoulder specialist, I’m asked a lot of questions about recovery from a rotator cuff injury.

Before answering that question, I find it’s necessary to step back a little and paint a picture.

The reason?

To build understanding and awareness about how recovery from rotator cuff injury can stall and how to avoid it.

Get inside your rotator cuff

To really pave the way to recovery from a rotator cuff injury, it’s necessary to get inside this important group of muscles and tendons.

Doing this helps you understand what you’re dealing with.

I like to think of the rotator cuff as the prime mover of the shoulder.

Made up of four key muscles from front to back, the rotator cuff includes the subscapularis, supraspinatus, infraspinatus and the teres minor (yes, I know it’s technical).

Ending as tendons which wrap around the ball of a bone called the humerus, their job is to centre the ball in the socket. They do this in the same way a golf ball balances on a tee.

Do you need to know this?

Well, maybe not the medical jargon.

But it is very helpful to know the rotator cuff – just as the name suggests – through this positioning, rotates the shoulder on many planes.

Rotation is movement. What most people don’t appreciate – at least not until they have a rotator cuff injury – is that the shoulder is designed for movement, not heavy loads (which frequently result in injury).

What’s the shoulder’s true function?

So, the true function of the shoulder is what?

Well, it’s to position your hand in space (not position your hand in space and then take a massive load).

When I explain this to patients, I see light bulbs come on.

They finally realise, their shoulder (yes, the very one they used for heavy lifting over the weekend and now causing them acute pain), was not designed for work like that.

The same light bulb shines brightly for those people who’ve been nursing – and perhaps ignoring – chronic shoulder pain caused by a rotator cuff injury.

Understanding how your shoulder works helps avoid injury. It also means you’ll enjoy a straighter pathway to recovery.

What happens when you have a rotator cuff injury?

If a rotator cuff tear occurs suddenly, for example, after an accident and function is lost, you’ll notice your shoulder is difficult to move.

When a tear occurs gradually, quite often other rotator cuff tendons will compensate and strengthen so the shoulder is quite functional.

The bottom line is, when placed under duress, the rotator cuff won’t hold up.

Whether it’s overuse or an accident, when the tendon tears away, a rotator cuff tear is what you’ll have.

Because the shoulder is a complex interplay of bones, tendons and muscles, a torn tendon can have an effect on the surrounding shoulder. This can cause bursitis, impingement syndrome or rotator cuff syndrome.

And none of this is good news. However, the road to recovery can be.

How to repair a rotator cuff injury

Successful rotator cuff repair is influenced by the interplay of many factors: the injury, the tendon’s capacity for healing, the surgeon’s diagnostic and surgical skills, the guidance and skill of the physiotherapist.

This makes an accurate assessment by your treatment team, a pivotal first step along the road to recovery.

My approach is to seek input from the patient, their family, general practitioner, and physiotherapist, if they’ve been working with one.

For me, collaboration is the best way to create an ideal recovery roadmap. A poor decision well executed rarely has a good outcome!

Regardless of whether it’s an acute or chronic injury you’re dealing with, there is a chance the first step to recovery may involve repair work.

Repair work may mean working with a good physiotherapist. It may also involve surgery.

The aim of the repair is to anchor the tendon back to the bone. This allows it to heal and move in the joint again, following an appropriate rehabilitation program.

Wondering where surgery fits in all this?

Certainly, surgery may be required for repair of your rotator cuff injury. Just be aware, though, scarring is an undesirable effect from ALL surgery.

Arthroscopic rotator cuff surgical repair aims to achieve healing of the tendon back to the bone, while minimising excessive scarring (adhesions).

Your outcome will depend on the surgeon’s skill level. It will also be influenced by the surgeon’s patience, when whether they can achieve this entirely or partially via keyhole surgery.

Some surgeons use an arthroscope-camera to look inside your shoulder to confirm the diagnosis, but then convert to an open operation.

Highly skilled surgeons will perform the entire operation with the arthroscope using small incisions through a portal.

This is my preferred mode of operation. Smaller incisions typically 1cm are used, ultimately decreasing the risk of infection and pain. It also tends to result in a faster recovery in terms of pain and a better cosmetic appearance from the incision.

Interested and want to know more? Get in touch.

Dr Sommit Dan is a leading Adelaide shoulder specialist. He provides minimally invasive and more complex treatment for all shoulder injuries and conditions. An Australian trained orthopaedic surgeon and highly skilled in arthroscopic (keyhole) shoulder reconstructions, rotator cuff repair and shoulder replacement surgery, Dr Dan treats patients as people. His goal is to his patients navigate the frequently challenging roadmap to recovery, empowering them along the way.