Rotator Cuff Repair Surgery - Diagnosis & Procedure

Rotator Cuff Treatments Options- Surgical and Non-Surgical

Rotator Cuff Surgery: Surgical Options

Different surgery options for rotator cuff surgery are as follows:

• Traditional open surgery: In this surgical procedure, a large incision is made on the shoulder to access the injured tendon. The surgeon then stitches the torn tendon back into the bone using conventional surgical tools. This surgical procedure helps in direct visualization and thorough repair but often entails a longer recovery period and increased postoperative discomfort compared to minimally invasive alternatives.
• Arthroscopic surgery: In arthroscopic rotator cuff repair surgery, the surgeon uses a small camera and specialized instruments through small incisions to address the injured tendon. This minimally invasive procedure provides a clear view of the shoulder joint on a monitor, enabling precise repairs. Arthroscopic surgery often leads to faster recovery, minimal postoperative pain, and smaller scars when compared to traditional open repair methods. 
• Mini-open repair: Mini-open repair surgery for rotator cuff entails a smaller incision, typically ranging from 3 to 5 cm in length. The surgeon utilizes arthroscopic guidance to assess the damaged tendon and then makes the necessary repairs through the mini-incision. This approach combines the benefits of both arthroscopic and open techniques, providing improved visualization and more extensive repairs than arthroscopy alone while still resulting in less postoperative pain and a shorter recovery period than traditional open surgery.

Benefits of Arthroscopic Rotator Cuff Surgery

Arthroscopic rotator cuff repair is highly effective in alleviating shoulder pain, restoring strength, and improving overall shoulder function. Patients also regain the ability to perform daily activities, overhead tasks, and sports without experiencing discomfort. Moreover, many individuals report improved sleep conditions as the chronic shoulder ache at night diminishes. With proper post-operative care and rehabilitation, this procedure enables patients to return to an active lifestyle, leading to a significantly enhanced quality of life. Some of the common benefits of rotator cuff surgery are as follows:

• Less invasive: Arthroscopic rotator cuff surgery involves only small incisions. A less invasive procedure ensures less surrounding tissue is impacted, allowing for reduced scarring, less pain, and a quick recovery.
• New developments in anchors: The development of new anchors, such as bioabsorbable fully-threaded suture anchors, allow the firm reattachment of the torn rotator cuff to the bone. Anchors can allow for better healing and functioning of the shoulder.
• Advanced surgical techniques: The use of knotless double row repairs increases tendon-to-bone contact and provides a secure fixation and arthroscopic assisted latissimus dorsi transfer for irreparable posterior rotator cuff tears.
• Fewer complications: Visibility with a tiny camera results in fewer chances of complications. Plus, with a smaller incision, there are fewer chances of infection than with open surgery.

Procedure of Rotator Cuff Surgery

Rotator cuff surgery is usually performed to mend a torn or injured rotator cuff in the shoulder using various techniques tailored to the tear’s size and severity. Before the surgery, a doctor suggests a comprehensive evaluation, including physical exams and imaging tests. A doctor also discusses the procedure’s risks and expected outcomes. The patient is then administered general anesthesia, which induces sleep, or regional anesthesia to numb the shoulder area. During the surgery, small incisions are made, and an arthroscope is used to visualize the tear and assess its extent. The damaged tissue is then repaired using sutures or fixation devices. Post-surgery care, rehabilitation, and physical therapy are crucial for a successful recovery.

How to Prepare For Rotator Cuff Surgery?

To ensure a successful and comfortable treatment journey during the preparation for rotator cuff repair surgery, follow these important steps:

• Discuss your medical history thoroughly with your healthcare provider including all the medications, supplements, and herbal remedies you are currently taking. If you are on any blood thinners or medications that might lead to anesthesia-related complications, then a doctor is likely to suggest discontinuing them before the surgery.
• If you have any pre-existing medical conditions like diabetes, heart disease, hypertension, etc., it is crucial to seek approval from your regular healthcare provider before proceeding with the surgery.
• Avoid the consumption of tobacco and alcohol, particularly smoking, several days before the surgery, as they can hinder the body’s healing ability.
• In case you develop a fever, cold, or any other infection before the scheduled surgery, promptly inform your doctor. They suggest you take appropriate precautions and may reschedule the surgery if necessary.
• Prepare an overnight bag, as you might be required to stay in the hospital for 1-2 days after the surgery. Additionally, refrain from eating anything after midnight on the day of the surgery, especially if the procedure involves general anesthesia.

By following these preparatory steps, you can ensure that you are in the best possible condition, and it also reduces the chances of complications during the surgery.

Recovery After Rotator Cuff Surgery

Enhancing your recovery from rotator cuff surgery involves following these essential tips:

• Utilize your sling or shoulder immobilizer for the recommended duration to provide support to the healing joint and discourage unnecessary arm movement.
• Opt for an upright sleeping position to reduce pressure on the healing joint. You can use pillows or a recliner to ensure comfort during sleep.
• Don’t hesitate to seek assistance from family or friends for everyday tasks such as showering and dressing, especially during the initial recovery period.
• Commit to your physiotherapy sessions and diligently follow the rehabilitation program prescribed by your physiotherapist.
• Prioritize rest and try to maintain a comfortable position that minimizes pressure on the operated shoulder.
• In the initial days after surgery, use ice packs for massaging the area to reduce inflammation. Once the post-surgery inflammation has subsided, switch to heat packs for massaging.
• Be cautious when moving your shoulder, and avoid putting excessive stress on the joint. Focus on wrist and finger movements while limiting shoulder movement.
• Recognize that complete recovery may take time, so avoid rushing yourself. Patience is key to ensuring proper healing and preventing setbacks.
• By adhering to these guidelines, you can optimize your recovery and support the healing process after rotator cuff surgery, regardless of whether it was arthroscopic or open surgery.

Risk & Complications Associated with Rotator Cuff Surgery

Generally, rotator cuff surgery is safe and effective in treating the condition, but like any surgical procedure, it also carries certain risks and complications. Some common risks and complications associated with rotator cuff surgery are as follows:

• Permanent loss of joint motion
• Weakness of the shoulder joint
• Allergic reaction to medicines/anesthesia
• Bleeding or infection
• Blood clot formation
• Failure to relieve the patient’s symptoms
• Permanent injury to a nerve, tendon, or blood vessel
• Re-tear of the tendon

It is important to note that complications usually occur during rotator cuff repair if the patient has weakened rotator cuff muscles before the surgery or has a very large tear.  In some cases, the surgery may also fail if the patient does not diligently follow post-surgery care tips and physiotherapy.

Cost of Rotator Cuff Surgery

The cost of rotator cuff surgeyr in India typically ranges from INR 60,000 to INR 75,000. This is the estimated cost of surgery the final cost can vary depending on various factors, including

• Type and severity of the injury
• Consultation and surgeon fees
• Patient’s age, gender, and health condition
• Diagnostic tests required
• Choice of hospital/clinic
• Duration of the hospital stay
• Anesthesia cost and anesthetist fees
• Type of hospital room
• Cost of postoperative care and follow-up treatment required
• Cost of physiotherapy
• Insurance coverage, etc.

Non-Surgical Treatments of Rotator Cuff

Non-surgical treatment options for rotator cuff are as follows:

• Rest and activity modification: A doctor usually recommends rest and activity modification to help reduce joint pain and swelling caused by a partial rotator cuff tear. Doctors also suggest correct ways to perform daily activities, such as lifting items or reaching overhead, to reduce the stress placed on your shoulder. The duration of rest depends on the severity of the condition. You can gradually resume your daily activities as the shoulder heals and symptoms subside.
• Medication: The inflammation of soft tissue surrounding a rotator cuff tear can cause pain and discomfort in the shoulder, especially while using the arm. Medications can significantly help in managing this inflammation. A doctor usually suggests taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, to reduce inflammation and pain. If severe shoulder pain prevents you from participating in daily activities such as going to work, doctors may suggest pain relievers for one or two weeks. These medications can mask pain and help you to function. Icing the shoulder periodically throughout the day can also help to reduce pain and swelling. Consult your doctor and ask about how often and for how long icing may be beneficial for you.
• Physical or occupational therapy: Physical and occupational therapies can help you recover from a torn rotator cuff. It helps you build strength and flexibility in the shoulder, arm, and back muscles. It also helps to stabilize the shoulder joint, relieve pain, improve range of motion, and prevent further tearing. A therapist also suggests how to safely perform daily activities, such as lifting your arm to wash your hair and how to modify your workspace to reduce stress on your injured shoulder. The number of weeks of physical or occupational therapy you do is based on the severity of the rotator cuff tear.
• Corticosteroid Injections: A doctor may recommend injections of corticosteroids, also known as steroids, if the pain becomes much more severe. These injections have strong anti-inflammatory properties and are typically only recommended if the medications fail to provide relief. A doctor limits the use of corticosteroid injections because their excess uses can weaken the tendons in the shoulder.

Questions to Ask Your Surgeon

Before undergoing rotator cuff surgery, it is important to ask the following questions to your surgeon to have a better understanding of the procedure and the risks and complications associated with it:

• Is rotator cuff repair a major surgery?
• How long does it take to recover from rotator cuff repair surgery?
• What is the best way to repair the rotator cuff?
• What are the different types of rotator cuff surgery?
• Can a rotator cuff heal without surgery?
• Is rotator cuff surgery safe?
• What are the best rotator cuff exercises?
• What is the success rate of rotator cuff repair?
• What are the rotator cuff surgery complications?
• What precautions do I need to take?
• How does rotator cuff tendinitis feel?
• How much does a rotator cuff surgery cost?
• What are the risk factors for rotator cuff surgery?
• What is the recovery period for rotator cuff surgery?
• Can the rotator cuff come back after surgery?
• Who needs rotator cuff surgery?
• How painful is rotator cuff surgery?

Signs of a Healing Rotator Cuff

Depending on the severity of the damage and each person’s health condition, the healing period can vary. The signs of healing in a rotator cuff injury typically take weeks or months. You can notice the following signs during the healing rotator cuff:

• Decreased pain: It is one of the major signs of healing. As the rotator cuff heals, you can feel a gradual reduction in shoulder pain and discomfort. While some initial discomfort may persist, it progressively diminishes.
• Improved range of motion: Healing typically results in an increased range of motion in the shoulder joint, making it easier to perform tasks that were previously painful or restricted.
• Reduced stiffness: Healing helps to decrease inflammation and swelling, leading to improved mobility and reduced stiffness in the shoulder.
• Decreased inflammation and swelling: As the injury heals, the swelling and tenderness around the rotator cuff area should subside, making the shoulder feel less swollen.
• Muscle strength improvement: Over time, you may experience increased strength in the shoulder muscles as the healing process progresses. It is important to follow a guided rehabilitation program to rebuild strength safely.
• Improved sleep: As the pain diminishes, you should experience more restful nights if the injury was previously affecting your sleep.
• Gradual return to normal activities: As the rotator cuff heals, you can gradually resume regular daily activities and exercises. It is advisable to seek guidance from a healthcare professional to prevent re-injury.

Remember that individual healing experiences may vary, and some rotator cuff injuries might require medical intervention, such as physical therapy, corticosteroid injections, or, in severe cases, surgery. If you suspect a rotator cuff injury or experience persistent pain and limited shoulder mobility, it is vital to consult a healthcare professional for a proper diagnosis and appropriate treatment plan.