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Rotator Cuff Surgery

A rotator cuff injury can develop in patients of all ages. In younger patients, this is usually secondary to the application of sports or trauma, while for older patients it’s due to age-related degeneration, wear and tear over time, reduced flexibility, and decreased muscle strength.

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A rotator cuff injury can develop in patients of all ages. In younger patients, this is usually secondary to the application of sports or trauma, while for older patients it’s due to age-related degeneration, wear and tear over time, reduced flexibility, and decreased muscle strength.

It is often seen as a weariness of the shoulder joint, defined by two variations:

  • Tendinopathy:

This is the result of the tendons being trapped between the bones at the top of the arm and the ones in the shoulder blade. Sometimes this is also called a subacromial or shoulder impingement. However, in this case, the tendons will tear over time due to the way the tendon, bone, and muscles are coming into contact with each other.

  • Rotator cuff tear:

This is when the rotator cuff has been partially torn or fully torn – it can happen suddenly through an injury or gradually over time.

Rotator cuff injuries can cause symptoms such as:

  • A dull ache
  • Shoulder pain – especially when you lift your arms
  • A feeling of weakness when move your arm from the shoulder
  • Not being able to move your shoulder completely
  • A clicking or grating sound when you move your shoulder

When considering rotator cuff surgery, it’s important to remember that while many patients receive successful results from this operation, every surgical procedure can carry potential risks. However, rest assured that the surgeon will discuss all available treatment options, to make sure that all non-operative alternatives have been exhausted. Most conditions can be treated non-operatively, but as a last resort you might be recommended for surgery.

Before

Before you receive surgery for your rotator cuff injury, you’ll first need to meet with the orthopaedic consultant, so that they can properly assess your symptoms.

Establishing a diagnosis involves taking a history and conducting an examination. This can involve scans, such as an MRI, ultrasound, x-ray to find out the severity of the problem, as this will also determine how we treat someone.

If, together with your consultant, you’ve decided that surgery is the right route for you, then your next step will be to schedule in the procedure to relieve your symptoms.

Before your surgery, you will need to come into hospital for a pre-assessment, where we can check your fitness for surgery. This is a standard check and includes a physical exam, blood tests, heart, and lung function tests.

If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

During

Your consultant will discuss your options for anaesthesia, such as general anaesthesia or local anaesthesia, and help you choose the best option for your needs.

The surgeon begins with an incision near your upper arm bone. The size and location of the incision can vary depending on the specific tear, its location, and the surgical technique being used. Common incision types include:

  • Arthroscopic approach: In this minimally invasive technique, several small incisions are made, and a tiny camera (arthroscope) is inserted to provide a view of the inside of the shoulder joint. Surgical instruments are then inserted through additional small incisions to repair the tear.
  • Open approach: In some cases, particularly for larger or more complex tears, a larger incision may be made to directly access and repair the torn tendons and muscles.

Once access is gained to the shoulder joint, the surgeon will carefully inspect the torn rotator cuff tendons and muscles. The damaged tissue is then repaired using one of several methods:

  • Sutures: The torn tendon is reattached to the bone using strong sutures (stitches). These sutures may be anchored to the bone with screws or other devices.
  • Tendon graft: In cases of severe damage or retracted tears, a graft from another tendon (autograft) or a donor tendon (allograft) may be used to bridge the gap and reinforce the repair.

Once complete, the surgical team then close the incision and take you to the recovery centre.

After

Once the anaesthetic has worn off, you may be released home on the same day. It’s important that you follow the advice of the surgeon and call the hospital if you feel discomfort or need additional pain relief.

After rotator cuff surgery, it’s likely that you’ll have some difficulty with normal activities for a little while. Following rotator cuff repair surgery, physical therapy and rehabilitation are essential for a successful recovery. You’ll have your arm in a sling for four to six weeks after the operation and a upper limb physiotherapist will work with you to gradually regain shoulder strength and range of motion. The rehabilitation process can take from six to twelve months, and it’s crucial to follow the therapist’s guidance and any postoperative instructions provided by your surgeon.

Medically reviewed by Mr Abbas Rashid - BSc(Hons) MBBS FRCS(Tr&Orth) on 02/02/2024

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.