Purpose

To relieve pain and improve rotator cuff function
Indications
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.
Skin Incisions

Sagittal, superior/lateral aspect of the shoulder. This is designed to give the best cosmetic results.
Approach
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.

Procedure

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
Arthroscopy

Excision of the acromioclavicular joint
Sub Acromial Decompression
Manipulation Under Anaesthetic

Main Possible Complications
Infection

• Impingement of the repair
• Recurrence of the tear
• Temporary or permanent nerve damage ( to the nerve supplying the rotator cuff muscles)
• Detachment of the repaired deltoid muscle
• Shoulder stiffness
• Development of pain from pre-existing degenerative gleno-humeral joint arthritis. Severe arthritis can develop as a result of a bad, neglected rotator cuff tear.

After the operation

0-2 weeks

An abduction brace (either 15 or 30 degrees ) is applied in theatre.
Avoid all active movements
Seen by physiotherapist to be shown how to safely remove and re-apply brace and to perform passive, controlled shoulder movements.

 
2 Weeks Post Op

Wound and sutures are reviewed by the hospital or practice nurse.
Pain levels discussed to keep under control
Physiotherapist assesses active and passive range of motion

4 Weeks Post Op

Surgeon reviews deltoid and rotator cuff function, pain levels, active and passive range of motion and neurological function.
Physiotherapist progresses to active assisted exercises.
6 Weeks Post Op

Physiotherapy session to progress to full active exercise and discard brace.

12 Weeks Post Op

Surgeon assesses active and passive range of motion, anterior deltoid function and rotator cuff function.
6 Months Post Op

Final Review

Assess active and passive range of motion
Discharge with continuation of physiotherapy or review in a further 3 months
Continue home strengthening exercise programme and plan return to chosen sports/manual work/heavy lifting.