Rotator Cuff Repair

The muscles from the shoulder blade attaches to the head of the humerus to stabilise the shoulder joint.
Tears can develop due to normal ageing and does not always need treatment unless they case persistent problems.
Tears that happen due to significant injuries in relatively young(less than 65y) and healthy, often need repair.

Acute tears after a significant injury in a healthy individual usually needs surgery
Chronic tears (that have become painful without a specific injury, unusually simply due to increased use) often can be treated without surgery.
In older individuals(over 65) and/or in people with significant medical problems(poorly controlled diabetes, severe heart or lung problems, smokers etc.) even acute tears are treated without surgery.
Treatment without surgery usually consists of.
Avoiding activities that hurt
Gentle physiotherapy
Anti inflammatories
Steroid injections

Acute tears in young, healthy individuals, or
Where non operative treatment is unsuccessful and
The injury stops you from doing the ‘things that you have to do’ such as getting dressed, making a meal, driving a car, or getting a good night’s sleep
and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read

This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)
Often the anaethetist does a nerve block (that numbs and paralyses the arm for about 12 hours) to help with pain relief – it can be very painful surgery.
Because it can be quite sore immediately after surgery - It is recommended to stay in hospital overnight
Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.

Surgery usually takes about 1-2 hours
But the whole process of going to theatre and waking up from surgery takes longer.
Often the surgery is done with the help of a camera (arthroscopic, or ‘keyhole’).

If the biceps tendon is damaged, it sometimes has to be released from inside the shoulder and reattached to the humerus.

If the AC (acromioclavicular) joint is very arthritic and painful it is resected

In Hospital

The wounds are dressed and the arm is placed in a sling
We often leave a pain catheter in the shoulder to deliver more local anaesthetic at about 10 hours after surgery (when the anaethetist’s nerve block starts to wear off)
Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
It is usual to leave hospital the morning after surgery
A physiotherapist will usually visit you in hospital to demonstrate gentle exercises.

At Home

Continue to stay on top of your pain with oral pain killers.
Do the gentle exercises that physiotherapist demonstrated in hospital. It is usually advised to see a physiotherapist in the community at around 4-6 weeks post surgery.
It is OK to remove your sling to do these exercises, but in most cases it should stay on at all other times for 6 weeks.
While the shoulder wounds are covered with waterproof dressings it is safe to have a shower. Please have the dressings replaced if they start to come loose.
An appointment is usually made at my rooms to review your progress at about 2 weeks after the surgery
Please do not drive before speaking to your physiotherapist or a doctor.

A sling is usually worn full time for about 6 weeks
From around 4 weeks on, a physiotherapist will show you how to start to progress your range of motion exercises.
From 6-12 weeks sling wear can be weaned shoulder movements increased under physio supervision.
Most moderately activities can usually be achieved by 3-4 months, but it will take 6 -9months to become completely comfortable and to return to maximal effort.
It often takes up to a year to regain completely normal range of motion.
Time frames
Self care (washing, dressing, eating) with the operated hand – usually around 4-6 weeks (a sling is still needed)
Driving: when you are able to control a steering wheel with your operated arm and you are not taking strong pain relief anymore (usualy 6-8 weeks post surgery)
Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)

Infection occurs rarely (1% of the time), but can be severe. It may need further operations, weeks in hospital. It can lead to a poor outcome.
There may be ongoing pain from other worn out joints in the area, that were not obviously a problem at the time of doing the surgery.
It is common to have a bit of numbness next to the scar. Very rarely, severe nerve damage can occur, resulting in paralysis or numbness in the arm.
Around 10-15% of the time more than expected stiffness occurs in the shoulder (frozen shoulder). It can take 2 years or more to get better.
The reconstruction can fail, may not heal completely, causing ongoing pain in the shoulder. Some studies have shown that it occurs in up to 20% cases.
A general anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

The biggest majority of patients experience significant improvement in their shoulder pain and function.
Mild discomfort and stiffness commonly persist despite successful surgery.
Strength usually recovers, but it can take up to 2 years to reach maximal improvement.
Tendons that were worn before the surgery will tend to tear again over the years after the surgery

How long will the surgery take / How long will I be in hospital?
about 2 hours, overnight
Which hospital?
The Sunshine Coast University Private Hospital
Or Kawana Private Hospital
Anything I should do to prepare for surgery?
You should make sure that you have no pimples or skin breaks around your shoulder.
if there are any pimples it should be washed with benzoil peroxide.
Stop any drugs or supplements that may cause thinning of blood (anti inflammatories, fish oil etc.)
Make sure that you have help at home for after surgery; you will need a sling for 6w and cannot drive for at least 6w
don't smoke
After care - showering, etc
as long as waterproof dressings are securely in place
Will I be in a sling?
yes for 6w
Worst case scenario
You can get a frozen shoulder that can take 2 years to recover.
The reconstruction can fail (and needs to be re done), or never be any good (uncommon in young healthy individuals.
Infection can make the shoulder worse than it is now, it may never recover (there is less than 1% risk of this happening)
Very rarely serious complications can occur from the anaesthetic, such as a stroke or heart attack.
Rehab - Who / Where?
first month: gentle exercises as demonstrated in hospital by physio
After that please see a physiotherapist in the community to help with further rehabilitation.
WC have requested a Medical table of costs – what is that?
We usually send a request for surgical approval to Workcover, it contains the item numbers(fees) that will be used.