If your painful shoulder doesn’t respond to non-surgical treatment, and it’s affecting your quality of life, your doctor may recommend surgery.
When a rotator cuff tendon tears, it’s no longer attaching properly to the head of your arm bone. Most rotator cuff tears involve the supraspinatus tendon, but other parts of your rotator cuff may be involved as well as the bursa (a cushion-like structure that helps reduce friction on the joint).
Your doctor will normally send you to have some imaging to confirm the diagnosis.
Often the tendon frays first. The damage can progress over time and the tendon can tear away completely. This can happen suddenly when you lift something heavy.
During this surgery, your surgeon will repair any tendon damage and then reattach your torn tendon to the bone using sutures. Small rivets, called ‘suture anchors’, may be used by your surgeon to help attach the tendon to the bone. The anchors, which may be made of metal or plastic, are left in place. Your surgeon may also remove any bony spurs that could rub on the underlying tendons.
Arthroscopic rotator cuff repair involves the use of a keyhole camera, known as an arthroscope, to look at the inside of your shoulder joint. Your surgeon makes very small incisions (1 to 2 cm) to insert the arthroscope together with thin surgical instruments and then repairs the tear.
Shoulder arthroscopy is technically demanding, so you’ll need to consult with a surgeon who’s skilled in this procedure.
Sometimes, your surgeon may need to change to an open procedure because of difficulties that occur during your surgery.
A mini-open repair is where your surgeon uses an arthroscope to examine the damage, then performs the surgery using an incision between 3 and 6 cm long. For this approach, your surgeon doesn’t have to detach the shoulder muscle.
With open surgery, your surgeon makes an incision several centimetres long to visualise the rotator cuff directly, rather than via an arthroscope. Your surgeon may have to detach the shoulder muscle to reach your torn tendon.
If you have a severe injury to your rotator cuff and the tendon can’t be repaired successfully, open surgery can enable your surgeon to do a tendon transfer. This is where a tendon from one end of the muscle is detached and reattached somewhere else. The tendon most likely to be transferred is the latissimus dorsi tendon in your back just below your shoulder.
Which approach is better?
Several factors determine which approach will be the best one for you. An open repair may be a better option if you have a large or complex tear or if your shoulder requires additional reconstruction. Your surgeon’s skill and experience is another factor to consider. The outcome and post-operative pain is likely to be the same for all 3 procedures but if you have arthroscopic surgery your recovery time may be shorter. You’ll also have less scarring with arthroscopic surgery or mini-open surgery vs. open surgery. If you need a tendon transfer, make sure your surgeon is skilled in the procedure.
Print this page and take it with you when you discuss your procedure with your surgeon.