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Rotator Cuff Repair Surgery in British Columbia and Alberta
Rotator cuff tears can be debilitating injuries, leading to pain and an inability to perform activities of daily living, or to comfortably participate in other recreational pursuits. If your rotator cuff problem has not improved with other non-operative treatments, you might be a candidate for rotator cuff repair surgery to help improve your pain and function. Book a consultation at Ortho South today with Dr. Anthony Costa to find out if rotator cuff repair surgery is appropriate for your shoulder condition.
Anatomy of the Rotator Cuff
The rotator cuff is defined by four muscles and their corresponding tendons: the supraspinatus, infraspinatus, teres minor, and sub-scapularis. The muscles start out on the shoulder blade (scapula), then become tendons as they attach to the top of your upper arm bone (the humerus). Depending on the location of attachment, and the line of muscle pull, the cuff muscles work together to help elevate and rotate the arm. The cuff tendons also work together to help balance the forces around the shoulder so that that humeral head (ball of the shoulder) stays centered on the glenoid (the shoulder socket).
In addition to the rotator cuff, several other anatomic structures around the shoulder help provide stability and improve the function of the shoulder. These structures include the bursa (a sac of fluid that helps the cuff tendons glide smoothly under the scapula), the biceps tendon (one of the attachments of the biceps muscle from the upper arm), the labrum (a soft tissue “bumper” that encircles the rim of the glenoid or socket of the shoulder), and the AC joint (a joint formed where the clavicle or collar bone meets a part of the scapula called the “acromion”). For various reasons, several of these structures are often affected when a rotator cuff tear is present, and can become “pain generators”, or sources of shoulder pain, that are separate from the rotator cuff tear itself.
Book a consultation at Ortho South today with Dr. Anthony Costa to learn more about which shoulder structures may be contributing to your symptoms, and to find out if rotator cuff repair surgery is appropriate for your shoulder condition.
Causes of Rotator Cuff Tears
Rotator cuff tears typically fall broadly into two categories: acute tears, and chronic degenerative tears. The “cause” of the tear in each category is usually different.
Acute rotator cuff tears are most commonly seen in younger patients (<40), with previously normal shoulder function, occurring after a major injury like a fall from height onto the arm or shoulder. These types of tears typically result in immediate pain, and loss of the ability to lift the arm. Often, these types of tears are less likely to improve with non-operative treatment, and tend to do better with early surgical care.
Chronic degenerative rotator cuff tears, are more likely to occur in older individuals (>40), without one single traumatic episode, and tend to develop worsening pain and loss of function more gradually. Some of the common causes of these types of tears injuries include: age-related wear and degeneration, repetitive overhead movements and/or overuse, minor falls and less traumatic injuries in the setting of already diseased rotator cuff tissues. These types of tears will often improve with non-surgical treatment in up to 70% of cases!
It is important to note that there is overlap between the two categories of tears, and no two cases are exactly alike. Book a consultation at Ortho South today with Dr. Anthony Costa to find out if rotator cuff repair surgery is appropriate for your shoulder condition.
The Importance of Surgery for Some Rotator Cuff Injuries
As mentioned above, not all rotator cuff tears need surgery. That said, early surgical intervention is often recommended for acute tears in younger individuals with new onset inability to lift the arm overhead following a recent trauma. Surgery in this setting will likely lead to better tendon healing, and ultimately improved pain relief, better shoulder strength, and quicker return to function.
In some chronic degenerative rotator cuff tears, surgery may still be recommended. Usually, patients will have exhausted other non-operative treatment options first. While the chances of improving pain and function with surgery in this setting are lower than in the acute/traumatic setting, repair of chronic degenerative tears might also help prevent progression of the tear. Tears that have become very large, retracted away from the insertion site, or have caused the muscle itself to begin to atrophy (shrink), may be much more challenging to repair later.
Moreover, chronic rotator cuff tears can ultimately lead to a specific type of arthritis of the shoulder joint called “rotator cuff tear arthropathy”. This happens over time because the ball of the shoulder joint starts to migrate up towards the bone of the scapula/acromion in the absence of a functional rotator cuff, leading to wear of both the ball and socket parts of the shoulder joint. Once a shoulder has developed cuff tear arthropathy, a repair of the rotator cuff will not be possible or helpful, and patients usually require a type of shoulder replacement called a “reverse total shoulder”. This is a special type of shoulder replacement that is designed to work in the absence of a functional rotator cuff.
Book a consultation at Ortho South today with Dr. Anthony Costa to find out if rotator cuff repair surgery is appropriate for your shoulder condition.
Understanding Rotator Cuff Repair Surgery
The primary role of rotator cuff repair surgery is to alleviate pain. Improved shoulder strength and function may come as secondary benefits. The surgery is usually performed on an outpatient basis (no overnight hospital stay required). Most of the time, the majority of the procedure will be performed arthroscopically (via small keyhole incisions), or at times with a “mini-open” technique, utilizing arthroscopy combined with a small incision on the side of the shoulder.
The first part of the procedure usually involves a “diagnostic arthroscopy”. During this part of the surgery, your surgeon will utilize a camera inserted through small keyhole incisions to evaluate the various structures in your shoulder, and help confirm any pathology suspected from your clinical history, physical exam, and/or diagnostic imaging studies . After this evaluation, the relevant pathology will be addressed surgically.
The actual techniques used to repair the torn tendons are extensive and are variable from case to case, as well as from surgeon to surgeon. In general, repair of a torn rotator cuff requires some means of sewing the torn tendon(s) back down to bone so that they will heal down to the bone permanently. This is usually accomplished with “suture anchors” (small anchoring devices with sutures attached that can be inserted into bone), simple sutures through the bone, or various other fixation devices.
In addition to repairing the torn rotator cuff tendons, other procedures are often performed concurrently to address additional pathology in the shoulder that can be associated with rotator cuff tears (ie to address other “pain generators” discussed above in the anatomy section of this page). Procedures commonly performed concurrently might include: bursectomy, sub-acromial decompression, acromioplasty, biceps tenotomy or tenodesis, distal clavicle excision. Details of these additional procedures should be discussed with your surgeon.
After surgery, patients are placed in a sling, and asked to avoid using their arm for any lifting for up to 6 weeks. This is to help protect the rotator cuff repair, and allow the tendon time to heal down to bone. If other procedures are carried out at the same time, there may be additional restrictions. It is important to note that if you do not adhere to the recommended restrictions from your surgeon, there will likely be a higher risk of failure of the repair to heal, with ongoing pain and functional limitations. A detailed, individualized, recovery protocol will be provided by Dr. Costa to you after your surgery.
Recovery After Rotator Cuff Repair Surgery
Recovery after rotator cuff repair surgery depends on many factors, including: chronicity of the problem, size of the tear, degree of tendon retraction, the number of tendons or other anatomic shoulder structures involved in the problem, muscle atrophy, and other patient factors to name a few.
While the post-operative course can vary based on the above factors, it is worthwhile noting that recovery after shoulder rotator cuff surgery can be extremely challenging for many patients. Patients can usually expect to be in a sling for 6 weeks, require a minimum of 3-4 months of physiotherapy to be able to perform overhead lifting or labour-type duties, and often need 10-12 months to reach “maximal recovery” (a point where no further improvements are likely to be seen).
Better outcomes are often seen in patients who diligently attend physiotherapy and/or perform appropriate home exercises during the entire recovery period. Simply using the arm for activities of daily living, or while at work is NOT equivalent to dedicated physiotherapy and focused rehabilitation exercises!
​Outcomes After Rotator Cuff Repair Surgery
Outcomes after rotator cuff repair surgery often depend on the category of tear being addressed.
Acute, traumatic tears, in younger patients, tend to have better surgical outcomes, compared with older patients with chronic degenerative tears, or acute-on-chronic tears. Patients with chronic degenerative tears may see improvements in pain and function in only 50-60% of cases.
Given the long and challenging recovery after rotator cuff repair surgery, it is critical to explore non-surgical treatment options with your surgeon in most cases before considering surgery.
Book a consultation at Ortho South today with Dr. Anthony Costa to find out if rotator cuff repair surgery is appropriate for your shoulder condition.
Potential Surgical Complications
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Bleeding or damage to blood vessels
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Surgical site and/or shoulder joint infections
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Nerve injury
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Blood clots
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Stiffness in the shoulder and/or elbow
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Ongoing shoulder pain
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Failure of the repair to heal
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Deltoid tendon or muscle damage
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Cosmetic deformity of muscles or joints around the shoulder
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Requirement for additional surgery
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Complex regional pain syndrome
Contact Ortho South Today to Discuss Rotator Cuff Repair Surgery
If you are navigating the discomfort of shoulder pain, and wondering if surgery may be an option, you've come to the right place! Get on track to reduce your shoulder pain, regain strength, and improve your quality of life with Ortho South. Contact Ortho South today to book a consultation with Dr. Anthony Costa to find out if rotator cuff repair surgery is appropriate for your shoulder condition.