Tears of the rotator cuff are common problems and can be due to degeneration of the tendons or injury. Once torn, they do not heal spontaneously.
When the tendon tear produces pain and weakness that have not responded to physiotherapy and home exercises, the tendon function can be improved with surgical reconstruction.
It is good to maintain a full passive range of motion of your shoulder because this improves the rate of recovery of motion after surgery. You will need about six weeks off work if you have a physical occupation so it would be best to have any time away from work organised before surgery.
I prefer to perform the surgery as an open procedure. There are several reasons for this approach. Firstly, the operation is quicker, there is no retention of a large amount of irrigation fluid and the length of the incision is commonly shorter than the three arthroscopic portals combined. The rotator cuff is approached through a small incision over the lateral aspect of your shoulder. Without detaching any muscle, the tendons are exposed and are then reconstructed with heavy duty sutures placed in tunnels in the bone. Generally, a complete repair is achieved. At the time of surgery, a block is inserted to ensure you have minimal discomfort when you wake up.
You will stay in hospital overnight mainly for good pain control. You will be resting in a sling for about six weeks but you will start physiotherapy early to regain passive movements in the shoulder joint. Also regaining movement helps to reduce pain as well. Active resistive training can commence about six weeks post-operative and how quickly you progress depends on how much training you can undertake at home.
The usual operative risks exist as for any shoulder surgery including blood clots, wound infection and failure of the repair to heal requiring repeat surgery. Such problems are quite rare. You may also develop stiffness of the shoulder due to adhesions binding up the tendon repair and for this a manipulation under anaesthesia may be required.
Before surgery is recommended, you will have had physiotherapy to improve the strength in the remaining intact tendon and if your pain is mild and power recovery good, surgery would not be required. Only if pain is troublesome and power recovery is inadequate will we recommend surgery.