Once the rotator cuff has been repaired there is a graduated mobilisation regime which involves intensive physiotherapy. The management is tailored according to the size of the tear, the age of the patient, fitness etc. Broadly speaking, as a guide, a patient can expect 4 weeks in the harness where the shoulder is immobilised. Following on from that there is a period of around 4-6 weeks of passive elevation where the shoulder is moved with the help of either gravity or the opposite limb or through the support of the physiotherapy. The purpose of this is to maintain the range of movement. After about 8-12 weeks a graduated mobilisation regime commences which consists of active movements. These will vary according to the size of the tear/ the quality of the tissues and will be adapted according to the patient. It can take up to 2 years for the full benefit of a rotator cuff repair to come through.
As in any surgical intervention there are small risks in relation to intervention, the type of anaesthesiae and those specific to the procedure.
The rotator cuff is a series of tendons, which are involved in the moving of the shoulder. They extend from the front to the top and all the way to the back.
The management of rotator cuff tears is tailored according to the needs of the patient, their expectations of physical activity and the debility that the rotator cuff is causing. The cuff is attached to the bald humeral head, which is part of the ball and socket articulation of the joint. When it comes off it can be due a combination of reasons, which include poor blood supply, attritional damage, longstanding wear and tear or major force. These are but a few factors that bring about rotator cuff tears. The effect of this is that once a full thickness tear has occurred it does not heal of its own accord. To repair the tendon involves re-suturing back to where it pulled off from, namely the rim of the humeral head. This usually involves preparation of the bony surface where the tendon is to be repaired on to and with the insertion of some anchors to allow the repair to hold. The arrival of modern anchors into shoulder surgery has allowed us the ability to repair rotator cuff tears with better results than was previously the case.
In large rotator cuff tears the tendon has to be mobilised from where it has retracted to. Once that is achieved it is repaired on to the bone. However, this does not mean that the patient can start mobilising gradually. Much time is required for the tendon to heal up. Up to 18 months is required for the ultimate plateau of recovery to come through. The tendon has to heal to where it has been repaired on to and the shoulder re-educated through physiotherapy to move in a co-ordinated fashion so as to unlearn the poor patterns of movement previously brought about by the tear.
Broadly speaking, the younger the patient is and the smaller the size of the full thickness element of the tear then the better the results are. It is estimated that something like 30% of patients will have irreparable rotator cuff tears. Through modern imaging and detailed clinical examination, we hope to pre-select this group beforehand, thus not putting these patients through unnecessary surgery. However, there are some instances when a complete repair is not possible.
The rehabilitation usually involves extensive physiotherapy, which usually starts with passive movements and gradually builds up to active and then resisted active movement. Whilst a rotator cuff tear would never give the patient a shoulder that was the same as they had in their youth, nevertheless we would always hope to achieve significant improvement on the function of the shoulder compared to the set of symptoms that were present when the full thickness rotator cuff tear was problematic.