Rotator Cuff Repair Surgery in Bath
Mr Chambler has been a Consultant Orthopaedic Surgeon in the United Kingston for the past 13 years. He qualified from St Mary’s Hospital Medical School, part of Imperial College London. Embarking on his surgical career, his interest soon became Orthopaedics and in particular shoulder and elbow surgery, being awarded his Masters of Surgery degree in this area by the University of London in 2000.
He gained his Shoulder & Elbow Fellowship with Professor Carr in Oxford and has since been awarded travelling fellowships by the British Elbow & Shoulder Society within the United Kingdom and Europe as well as to the world renowned Mayo Clinic in the United States of America.
Shoulder anatomy
The main shoulder joint, the glenohumeral joint (GHJ) is a ball and socket joint, providing a very wide range of movement. It is formed by a ball on the top of your arm bone (humeral head) and a shallow socket (glenoid) which is part of the shoulder blade.
The joint is surrounded by a tough fiberous sleeve called the capsule which helps hold the joint together.
Above the ball and socket joint is a ligament which is attached to a bony prominence (the acromion) on the top for your shoulder blade. This forms an arch over the shoulder joint. This area above the shoulder joint and below the arch is known as the subacromial space.
To move your shoulder and control the positions of the ball on the socket, you have a group of muscles and tendons known as the rotator cuff.
They attach from the shoulder blade onto the top of the humeral head, passing through the subacromial space. One of these tendons (supraspinatus) sits in the middle of the subacromial space. A small fluid lining called the bursa cushions this tendon from the under the surface of the arch.
Shoulder Conditions
Rotator Cuff Tear
The rotator cuff can tear either traumatically, through a fall, wrenching of the arm or lifting something to heavy; or as we age, the rotator cuff tendon can wear and degrade, becoming weak and increasingly prone to rupture or tear.
If the rotator cuff tendons or muscles tear, you will find it very difficult and/or painful to lift or rotate the arm away from the body with the same range of motion as before the injury. Pain at night is also very common, often radiating down the arm.
What are my treatment options?
A traumatic, full thickness tear to an intact cuff will generally require a surgical repair and the sooner this can be done after injury, the better the outcomes for you.
A traumatic partial thickness tear or the atraumatic, degenerate tears generally don’t always require surgical repair. The initial treatments include; advice and education into the condition, painkillers, self-help strategies, Physiotherapy and injections.
As you are attending the Orthopaedic clinic, many of these should have already been tried. Meaning you have probably had the problem for some time, or that it is severely affecting your daily life and therefore the surgical options now need to be considered.
Long Head Of Biceps (LHB) Tendon Rupture
LHB usually ruptures during a forceful action or trauma, such as a fall or lifting something to heavy. Typically pain is instant, often accompanied by an audible ‘pop’. Depending on your individual functional requirements usually surgery is not required.
Assessment
What Tests Have To Be Done?
These shoulder conditions are diagnosed from the symptoms you have discussed with your doctor and findings of the examination of your shoulder. Either an ultrasound scan or MRI may be performed to assess the rotator cuff tendon and muscle, and other soft tissues.
Surgery
Rotator Cuff Repair
The surgery is usually performed arthroscopically (where a camera is placed inside the joint) however sometimes it may be done as an Open procedure or a combination of the two, called a Mini-open repair.
A rotator cuff repair involves stitching the torn tendon back onto its insertion at the top of the arm bone (humerus) using sutures and bone anchors.
Your surgeon will perform other procedures on the shoulder alongside the rotator cuff repair in order to maximise your chances of the best outcomes.
These will include:
Pre-surgery considerations
Appendix
Post-Operative Exercises
All exercises should be performed out of the sling, three to four times per day once the nerve block has worn off and should not cause any significant increase in pain. Use the ‘safe-zones’, ‘pacing’ and ‘soreness rules’ to guide the progression of your range of movement and repetitions as guided by your outpatient Physiotherapist. If you have any concerns regarding the exercises please call the hospital.
Gentle mobility exercises to be performed while using the sling to avoid your joints stiffening up:
1. Neck – bend your head forwards, to each side and turn to look over each shoulder 4–5 times.
2. Shoulder blades – roll your shoulder blades forwards and backwards 4–5 times. Sometimes the operated side can be stiffer and harder to control, do them in front of the mirror to help perform them evenly.
3. Elbow – bend your elbow up and down 4–5 times, then with your elbow at 90° turn your hand over and over 4–5 times.
4. Wrist and hand – bend your wrist up and down 4–5 times, then stretch your fingers out and make a fist 4–5 times.
Specific shoulder exercises to be performed up until you see your outpatient Physiotherapist:
5. Shoulder passive forward flexion
Lean forwards allowing your arms to gentle come away from your body. To a maximum range of _____________ as comfort allows.
Hold for three seconds and stand back up. Repeat 4–5 times.
N.B. Try to avoid your shoulder blade ‘hitching’ up, by drawing it back (arrow)
6. Shoulder passive external rotation
Keeping the elbow close to the body, use your non-operated arm to gently guide the hand of your operated arm outwards, to a maximum range of____________ as comfort allows.
Hold for three seconds and bring your hand back to the start. Try to avoid your body turning, your shoulder blade dropping backwards or your upper arm coming away from the side of your body. Repeat 4–5 times.
