The rotator cuff is formed of 4 muscles
They form a cuff over the top of the humerus.
They have two roles a) to rotate the humerus on the glenoid. b) To provide stability by compressing the humerus into the glenoid socket. They contract as a unit before any other muscle in the shoulder, anchoring the joint to allow the larger muscles around the joint, such as the deltoid, to create movement of the arm. In effect they are needed to counteract the forces developed by the large external muscles ( e.g deltoid and pectoralis major)
The most common site of a tear is within the supraspinatus muscle, but any or all of the muscles can be affected.
Tears cause a problem because the joint looses its stability and other problems arise as a result of this, such as impingement and lesions of the biceps. Ultimately, large, untreated tears can lead to severe,early secondary osteoarthrosis.
A tear is most common in people over the age of 40 due to degeneration of the tendon structure or lack of specific exercise , but can also occur in younger people as a result of an injury.
Common examples of when an injury is likely to occour :-
Signs and Symptoms
• Pain at the front or side of the shoulder which radiates down the side of the arm.
• Physical examination
|RC: Rotator cuff, B: biceps HH: humeral head
Arthroscopic view of a rotator cuff tear. A large space can be seen between the humeral head and the edge of the rotator cuff
Managed conservatively, without surgery, it will take several months of exercise to regain the strength necessary to stabilise the joint.
Surgery – Rotator Cuff Repair – The type of surgery depends on the size, shape and location of the tear. A partial tear may require only a trimming or smoothing, a procedure known as debridement.
A larger tear in the substance of the tendon is repaired by suturing the two sides of the tendon. If the tendon is torn from its insertion onto the greater tuberosity of the humerus it can be repaired directly onto the bone.
ROTATOR CUFF REPAIR
To relieve pain and improve rotator cuff function
Patients with pain or difficulty elevating the arm against gravity or lifting ,from repairable rotator cuff tears, either degenerate or tears resulting from an injury e.g sudden, heavy lifting.
Sagittal, superior/lateral aspect of the shoulder. This is designed to give the best cosmetic results.
The deltoid is divided between its fibers and detached from the front of the acromium to provide access to the torn rotator cuff. An acromioplasty is usually also required(link). This increases the sub acromial space and reduces the possibility of impingement and recurrent tear.
The rotator cuff tear is located (most commonly in the supraspinatus tendon). The tendon is carefully released of all adhesions and bought back to its original position. It is then repaired, without tension directly to the bone utilizing small anchors secured within the bone. The bone surface has to be carefully prepared.
Possible Associated Procedures
Main Possible Complications
After the operation
An abduction brace (either 15 or 30 degrees ) is applied in theatre.
2 Weeks Post Op
Wound and sutures are reviewed by the hospital or practice nurse.
Surgeon reviews deltoid and rotator cuff function, pain levels, active and passive range of motion and neurological function.
6 Weeks Post Op
Physiotherapy session to progress to full active exercise and discard brace.
Surgeon assesses active and passive range of motion, anterior deltoid function and rotator cuff function.
6 Months Post Op