Rotator Cuff Repair
A comprehensive guide to rotator cuff repair surgery
The rotator cuff repair procedure
Surgery is performed under a light general anaesthetic. Sometimes the anaesthetist also gives a ‘nerve block’ to the arm and shoulder, which numbs the nerves for a short time to ease the pain after surgery and expedite the early recovery process.
The surgeon then performs the keyhole (arthroscopic) procedure via 3-4 very small cuts (portals). Each one is only about 3-5mm long, through which specialised instruments - including a telescopic camera, a bone shaver and tendon repairing equipment - are guided.
The surgeon will often first perform a procedure called subacromial decompression. This widens the tight bony channel, removing bone spurs and inflammatory tissue to enable the repaired tendon to glide more smoothly along its normal path. Next, they repair the torn tendon. They then clear away the scar tissue, place an anchor into the top of the arm bone (humeral head), and finally repair the torn tendon back to the bone.
The operation takes approximately 90 minutes and most patients leave hospital on the day of surgery.
The condition and diagnosis
The shoulder is a ball and socket joint surrounded by a group of muscles and tendons called the rotator cuff. These keep the shoulder joint stable and enable the shoulder to move. The rotator cuff contains four tendons: the supraspinatus, infraspinatus, teres minor and the subscapularis. The rotator cuff passes through a narrow channel in the shoulder joint underneath a bony part of the shoulder blade called the acromion.
Some people naturally have a narrower channel or have an acromion that is slightly more bent. A tighter channel can cause the surrounding bone to squeeze and rub the rotator cuff as it passes through this space. Repetitive movement of the tendon through the tight space can cause the tendon to rupture.
As the tendon is naturally under tension, if it is fully ruptured, it will separate and recoil. Unfortunately, a torn tendon cannot heal itself. If left untreated the tear size can get bigger and lead to irreversible arthritis in some cases. Usually, however, the tendon is repairable and rotator cuff surgery offers a good long term result.
Preparing for rotator cuff surgery
Before proceeding to surgery, you will need diagnostic imaging such as an X-ray, MRI or ultrasound to confirm the extent of your injury and any other associated issues. The surgeon will discuss the condition, treatment options and plans with you at your consultation. You will also need pre-assessment checks to ensure you are safe to proceed with surgery.
It is recommended that you organise to be driven home after your surgery and that you receive support to help you for the first few days after leaving the hospital.
Recovery from surgery
Most patients go home the same day but may need a chaperone to go home with, and stay with them for the first 24 hours after surgery. Patients will also typically be asked to wear a sling for about a month following surgery in order to protect the repair whilst it is healing. During this time your consultant will provide clear instruction and advice about what you can do with this arm, however, it is very limited in the first month.
Subsequent to this, regular physiotherapy is crucial to achieve a gradual and progressive return to function, in a step-by-step manner. Your consultant will recommend the best follow-up routine and physiotherapy programme depending on the injury and surgery performed.
Recovery can take up to 6 months - and sometimes as long as a year to achieve the full range of shoulder mobility.
What are the potential complications of rotator cuff repair surgery?
Rotator cuff repair surgery is considered a low-risk surgery though some complications are possible. These include bleeding, infection and nerve damage, though all of the aforementioned issues occur in fewer than 1% of patients and a good hospital will mitigate the impact of any complications should they arise.
There is also the potential for a condition called frozen shoulder to arise where patients can feel stiffness in the shoulder that was operated on, though this typically subsides within a couple of weeks. The greatest risk factors for complication come down to the nature of the damage to the tendon which a consultant will be able to expand upon in each particular case.
Should complications relating to your surgery occur which require you to have further treatment in theatre (another operation within 12 months), our Protect my Care insurance policy will refund the cost of your original care. This policy is included in your care at no extra cost to you.
How to judge the best hospital and surgeon for you
Surgeon and hospital performance
Generally, a specialist consultant shoulder surgeon who undertakes a significant volume of procedures each year is likely to give you a good outcome from your surgery. In general, the higher the volume of rotator cuff repairs a surgeon performs each year, the greater their expertise will be.
From a hospital perspective, a dedicated orthopaedic ward (with only screened elective orthopaedic patients), senior resident doctors, dedicated specialist nurses and physiotherapists, and a dedicated pain control team are desirable to carefully manage your post-operative care and pain and identify potential complications early.
Hospitals vary considerably in the way post-operative complications are dealt with - both clinically and financially - so this is worth understanding further prior to self-funding.
Hospitals collect two main types of information from patients: direct reviews and outcome scores. Compare my Care look carefully at reviews and outcome data before helping you choose the hospital and surgeon to suit your needs.
Paying for Treatment
The price of a rotator cuff repair ranges from £4,500 to over £8,000 with the biggest difference factor being the hospital you select. This figure generally consists of hospital costs, surgeons fees, anaesthetic fees and occasionally extra imaging and implant costs.
Depending on the hospital in question, the price quoted on a hospital’s website will most likely be a guide price. Typically, it won’t include other aspects of your treatment such as the initial diagnostic workup. We aim to provide you with a fixed price for your procedure, hospital stay and surgeon follow up.
How Compare my Care works for you
Compare my Care works by analysing surgeon and hospital volume and performance data, each hospital's facilities and CQC ratings, and available patient experience information to help patients find the best private healthcare providers for their care.
Our experienced concierge team will work with you to arrange an initial consultation with the surgeon at your selected hospital.
Please note: Compare my Care does everything possible to secure a fixed price for each procedure, but individual medical needs may result in diagnostic and treatment variation which can impact costs.
Introducing Protect my Care
‘Protect my Care’ is a unique ‘cash-back' insurance policy provided by Compare my Care. It was created to give patients additional protection and peace of mind when paying for their own surgery - and comes at no extra cost to the patient.
All surgeries come with risks but in the hands of a super-specialist surgeon these can be reduced further. However, in the rare event that a repeat surgery is needed within 12 months, patients will be refunded the cost of their original procedure - to spend as they see fit.