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A Guide for Rotator Cuff Surgery
"Impingement Syndrome" is a condition in which a portion of the rotator cuff "Impinges" on under surface of the acromion. This results in pain in the shoulder. The pain frequently occurs with movement of the shoulder. The shoulder often aches at night particularly when lying on it. Frequently people notice a clicking sensation arising from the joint with certain movements of the joint.
The muscle which controls the shoulder joint converge on the joint and form a "cuff" of tendons around the joint. This tenderness cuff is known as the "Rotator Cuff". These muscles stabilize the shoulder and assist with movement of the shoulder.
The rotator cuff usually moves smoothly beneath the acromion. However occasionally the rotator cuff can begin to catch on the acromion and cause the so called impingement syndrome. This can sometimes occur for no obvious reason. However the problem can also be brought about by excessive repetitive movements of the shoulder. In older people a "spur" forms on the acromion and this can irritate the rotator cuff. Sometimes the rotator cuff can be torn either as a result of rubbing on the acromion or as a result of an injury. The older people the rotator cuff is weaker and sometimes tears with only minimal force.
The Operation: The principal of the operation is to remove sufficient bone from beneath the acromion to allow the rotator cuff to move without "impinging" on the acromion. If the rotator cuff is torn or damaged then attempt is usually made to repair the tear. This may not also be possible particularly if the tear is very large. The sutures which as used to repair the rotator cuff are relatively weak in comparison to the muscle around the shoulders and can easily be torn following surgery if the shoulder is moved in the wrong way.
What Happens after the operation: On your return to the ward after the operation, you will have a drip in your arm to supply you with fluid until you are able to eat and drink. The shoulder wound will be covered with a dressing and you may also have a drain coming from the shoulder to drain away blood and other fluid from the surgery.
This type of surgery is usually quite painful and you will need injections to control the pain. These pain killing injections can either be given as a conventional injection or sometimes as a "PCA".
Your arm will be immobilized in a sling. The purpose of this sling is to keep the arm in a comfortable position and more importantly to avoid movement of the shoulder which might tear any of the stitches which were used to repair the tendon.
Exercises:
There is usually a delicate balance between vigorous movement of the shoulder which would almost certainly tear the stitches in the wound and between completely mobilization which would result in prolonged stiffness of the shoulder. There is no hard and fast rule about the type of exercises which may or may not be done. The exercise program following the operation will have to be "tailor made" depending on the strength of the repair of the tendon. This will have to be discussed with the surgeon who did the repair.
As a rule of thumb the exercises which put the least strain on the tendons are "Pendulum exercises" and "passive movement".
Following the surgery and repair of the rotator cuff the muscles slowly heal. However this is unusually slow process and the repair does not become even moderately strong for about six weeks and full strength is not obtained for many months.
People generally require two to five days in hospital with this type of surgery. If a simple acromioplasty was performed no repair of the rotator cuff was required then it generally takes three or four weeks before the arm can be used for over head activity. However if the rotator cuff required repair then it may take as long as several months before over head activity can be undertaken.
What can go wrong: The most serious problem which can sometimes show up soon after discharge from hospital is a infection in the wound. Signs of this occurring are: 1. Increasing pain in the wound. 2. A fever. 3. Increasing redness in the wound. 4. An offensive smell from the dressing. 5. Persisting discharge or oozing from the wound.
If you think the problems is arising, you should contact your surgeon or your general practitioner or the emergines care centre at the John Flynn Hospital. |
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