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Rotator cuff muscles cover the shoulder joint. Their duty is to provide the power to lift and rotate the arm. With age, these muscles become thinner and weak, thus prone to rupture, even with minimal trauma. Rotator cuff muscles are usually seen at the junction of the muscle with the tendon, which is the part of the muscle that goes into the bone.

Unfortunately, complete tear of rotator cuff muscles does not repair themselves. Left unattended, it can lead to progression of the tear with subsequent loss of motion and power. The longer a tear left untreated, the bigger it gets, the more movement and strength one loses. The result of a surgical outcome is better in small tears than large ones, thus making it all the more important to seek a medical opinion. The longer the time taken to get to the hospital, the less satisfactory the surgical result is likely to be.

Generally patients get intense pain with lifting of the arm, discomfort at night, inability to move the arm and feel lack of power. Eventually, they may lose shoulder motion significantly.

Non-operative methods of managing a rotator cuff repair is best for smaller or partial tears, provided it does not involve anything that would put the shoulder under severe stress. Nonetheless, if the tear is moderate to large or the damage is significant, then surgery may be right choice.

Arthroscopic procedures are generally chosen in cases where the tear is a small to large size. One of the benefits of arthroscopic procedure is rehabilitation is quicker.

An arthroscopic rotator cuff repair is a reasonably major surgical procedure that involves six-month rehabilitation period. The outcome is generally very positive, but it does not mean that your shoulder is back to its normal condition. The objective of the procedure is to repair the torn muscle to the part of the bone from which it got detached.

Pre-operative stage

You have to be admitted to the hospital before the procedure and an anesthetist will visit you to examine and make sure you are fit enough to undergo anesthesia. The type of anesthesia used is up to the surgeon and anesthesiologist. You must take off all the jewelry like rings, bangles etc before the procedure.

Operative procedure

Two or three small incisions, each the size of a dime, are needed to insert the scope and other specialized instruments. The joint is filled with sterile fluid to allow the surgeon to see more clearly. Most procedures take less than one hour to perform.

Post procedure

After the procedure you may wake up in the ward with your arm in a sling or a special shoulder immobilizer depending on the type of surgery performed. You will be informed clearly whether you can move your arm immediately post procedure. In order to decrease pain and swelling, icing and anti-inflammatory medicines may be used. The rotator cuff muscle takes six weeks to heal to the bone. To avoid stiffness, patients are asked to do some specific exercises of the shoulder following the operation. It is quite normal for the exercises to cause some discomfort and pain.

If no untoward signs are noticed, you will be discharged from the hospital on the day after surgery. It is normal to feel pain around the shoulder in the immediate postoperative period. You may even experience pain at night as a result of surgery. Painkillers and tablets may be prescribed to relieve pain and help you sleep at night.

It is important to keep the surgical area dry while showering for the first three to five days. After this, dressing can be changed after bathing with utmost care. You can begin gentle exercises after a week. No need to see a physiotherapist during this period unless you cannot do these exercises by yourself.

Returning to normal day-to-day activities may take several weeks to several months depending on the type of operation you had undergone. It is best not to return to jobs that involve heavy lifting and overhead activity. This is because there is intrinsic weakness in the rotator cuff and heavy activity increases the risk of re-rupture. The success rate of the surgery is in the vicinity of 90%. The success rate and return of function is very dependent on the extent of the tear. If you choose not to have surgery, the tear will never heal. With time the tear will progressively increase in size, leading to an increase in loss of function.

As with any operation, your surgeon will be the best source of advice regarding the appropriate postoperative care.

Benefits of arthroscopic rotator cuff repair

Benefits of arthroscopic surgery compared with older open surgical techniques include:

• Minimal scars
• No overnight hospital stay
• Decreased pain and swelling
• Improved motion
• Quicker functional recovery
• Fewer risks and complications