The rotator cuff is comprised of four muscles and their tendons that attach from the scapula to the humerus. The muscles of the rotator cuff help stabilise the shoulder and enable you to lift your arm. The rotator cuff tendons can acutely tear or wear out as a result of degenerative changes.
If the tear is causing significant pain and disability, surgery may be the best treatment to relieve pain and improve shoulder function. If a torn rotator cuff is not repaired, the shoulder often develops degenerative changes and arthritis many years later.
The three surgical techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. The type of repair performed depends on several factors, including your age, the size of your tear, your anatomy and the quality of the tendon tissue and bone.
The surgeon will choose the technique that is best for your repair. You may also have other shoulder problems in addition to a rotator cuff tear, such as osteoarthritis, bone spurs or other soft tissue tears. This will be addressed at the surgery also. There are three stages of recovery following a rotator cuff repair. These include the protection stage, rehabilitation stage and functional restoration stage.
Tendon healing is a slow process. It takes six weeks before it is safe to start using the arm under its own power. You need to be in a sling for six weeks following your shoulder operation. Your sling must stay on at all times, day and night except when you are performing your exercises or in the shower.
The goals of the protection stage are to allow healing of tendon to bone, protect the rotator cuff repair, control the post-operative pain and inflammation and initiate a range of motion exercises to reduce post-operative shoulder stiffness. During the protection stage, DO NOT raise your arm or elbow away from your body. Also, NO lifting of objects, no reaching behind, no excessive stretching or sudden movements and NO supporting of your body weight by your hands.
It is essential that you regularly loosen or release the sling to exercise and move your elbow, wrist and hand to prevent stiffness of these joints. This should be done at least four times per day. You will wear your sling over your clothes after your surgery. Always dress your operated arm first and undress it last. You will require loose clothing that preferably buttons down the front or tank tops with large sleeves. Avoid clothing with small buttons, hooks and zips. Ladies may find a bra uncomfortable and may prefer to wear a strapless or front fastening bra. To wash under the operated arm, bend over at the waist and let the arm passively come away from the body.
At six weeks the sling can begin to be weaned off. It is advised to wear the sling around large groups of people to avoid knocks. You are now able to use your arm actively or raise it on its own without the support of the unaffected arm.
The goals of the rehabilitation stage are to continue to protect the repair whilst beginning to restore range of movement (6-12 weeks) and restore strength (9 weeks+). Even though your tear has been repaired, the muscles around your arm remain weak. Moving your muscles on their own will gradually increase your strength and improve your arm control. During the rehabilitation stage, you are able to lift light objects but DO NOT lift anything heavier than 2kg, pull anything heavy or suddenly and avoid overhead lifting.
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