Rotator Cuff Surgery

The rotator cuff can be damaged by traumatic injuries or repetitive overuse during work or sport activities. It may also be affected by degenerative processes due to aging, calcification or spur formation in the overlying acromion. The various types of rotator cuff surgery that our Consultants offer are listed below.

Rotator Cuff Disease

What Is The Treatment Of Rotator Cuff Disease?

Treatment depends on the stage of the disease. In the early stage of tendonitis, anti-inflammatory medication and simple painkillers may help, in addition to modifying daily activities to avoid excessive or repetitive lifting of the arm, where possible.

If these measures do not help, injections of cortisone (an anti-inflammatory drug and one of the body’s natural hormones) into the bursa may help relieve inflammation more directly. However, if there is a more mechanical element to the pain, then physiotherapy to rebalance the muscle strength around the shoulder and open up the space for the tendon, may also prove effective.

In some cases where there has been no response to these treatments, surgery may be indicated. In our Unit, the most important surgical procedure for impingement syndrome is arthroscopic acrominioplasty (also called subacromial decompression). In this “keyhole” operation a small amount of bone is shaved from the underside of the acromion to make more room for the tendon to slide underneath. If a tear is present, it may be combined with trimming of the tendon (debridement) or repair of the tendon. In more complex cases repair may not be possible through a keyhole approach, and an open incision may be required. If the tendons are not repairable, then sometimes a debridement procedure can provide good pain relief, although other options include using other tendons to replace the torn tendon, or a special type of joint replacement.

Arthroscopic Subacromial Decompression

If a patient has impingement (tendonitis, bursitis) and non operative measures have failed, an arthroscopic subacromial decompression may be performed.

The aim of the operation is to remove inflammatory tissue and increase the space for the rotator cuff tendons to move, reducing the friction between the overlying structures and tendons. In order to accomplish this, a small amount of bone is shaved away from the acromion making a smooth surface and soft tissues (including a ligament) are released.

The operation is usually performed with regional anaesthesia involving a nerve block to the arm, together with sedation or general anaesthetic depending on the individual. In some cases the patient may remain awake during the procedure and indeed watch the operation on the monitors in theatre. The operation is generally performed as a day case or over night stay if performed late in the day.

2-3 small (0.5cm) wounds are required to place arthroscope (camera) into the shoulder, together with the instruments to perform the operation.

Following the surgery the arm is placed in a sling for 2 – 3 days. By 2 weeks post surgery, the patient should be able to raise the arm above shoulder height, achieving full range shortly afterwards, as the bruising from the operation resolves. Patients resume driving 1-2 weeks after the intervention. Physiotherapy is commenced.

By 8 weeks postoperative, a full range of movement and reasonable strength should have returned. Patients often state that the shoulder is OK but is not yet 100% normal. Over the following 3 months, the shoulder regains strength such that 85% of patients will consider the results of the operation to be good / excellent, with 14% satisfactory, though 1% of patients may be disappointed with progress.

Rotator Cuff Tear Surgery

A complete rotator cuff tear will not heal and generally complete tendon tears require surgery to allow the healing process to take place. The surgery can be performed either arthroscopically (keyhole surgery) or through an open technique.

In our Unit, the majority of procedures are performed arthroscopically, as this minimises potential risks and complications, reduces postoperative pain and hospital stay and also allows quicker rehabilitation. It should be recognised however that this is a technically demanding procedure requiring specialised training.

The surgery involves stitching the torn tendon back to the bone from which it has been detached (humerus). In order to secure the tendon to the bone, the sutures are connected to metal/bio absorbable anchors which are embedded into the bone. This provides a secure fixation point. The sutures are then passed through the torn tendon, which is then tied back to the bone. Up to five anchors may be required to achieve a satisfactory fixation of the tendons, such that it is attached back to its original footprint on the bone.

The operation is usually performed with regional anaesthesia involving a nerve block to the arm, together with sedation or general anaesthetic depending on the individual. Because of the time taken to perform the surgery, together with its complexity , patients rarely remain awake during the procedure. The operation is generally performed as a day case or over night stay if performed late in the day.

4 – 5 small (0.5cm) wounds are required to place arthroscope (camera) into the shoulder, together with the instruments to perform the operation.

As part of the procedure, a subcromial decompression is also performed (see above), to allow more space for the repaired tendons to move, once rehabilitation is commenced.

In order for the tendons to heal, the arm will be immobilised in a sling for at least 3 weeks before the shoulder range of movement is re-established. During the initial period many patients experience significant sleep disturbance and regular analgesia is likely to be required. A strengthening programme is subsequently employed usually allowing light weights 6 – 8 weeks post surgery. Rehabilitation my continue for 6 months following the procedure. Commitment to the physiotherapy programme is fundamental to the success of the surgery.

95% of patients undergoing arthroscopic rotator cuff repair are satisfied at 2 years follow up.

If a tendon is partially torn then either the tear will be simply debrided and or it may be completed to allow a formal repair to be performed. Often the decision is not made until the tendon injury has been directly visualised with the arthroscope (camera). Your surgeon will discuss the rationale for treatment before the operation. It should be recognised that if a formal repair is undertaken, there is a necessity for a sling for 3 – 4 weeks post intervention. A subcromial decompression will generally also be performed.

london orthopaedic clinic

Private Orthopaedic Clinic

The Orthopaedic Unit at St John & St Elizabeth Hospital is one of the country’s leading private orthopaedic centres. We provide a complete service for the assessment, treatment and management of orthopaedic and musculoskeletal problems.

A patient speaking to a receptionist

Patient information

Our Hospital is renowned for providing exemplary levels of care across more than 90 services. From orthopaedics, to urology, our private GP practice and Urgent Care Clinic, our services are led by some of London’s leading Consultants. For more information, and to find a service suitable for your care, find out more about the services that we offer.

Make an enquiry

If you have any questions relating to treatment options or pricing information, get in touch with us by filling out one of our contact boxes or giving us a call on 0207 078 3891.

Our Appointments Team have a dedicated and caring approach to finding you the earliest appointment possible with the best specialist.

If you are self-paying you don’t need a referral from your GP for a consultation. You can simply refer yourself* and book an appointment.

If you have health insurance (e.g. Bupa, Axa Health, Aviva), you will need to contact your insurer to get authorisation before any treatment, and in most cases you will also require a referral letter from your GP.

If you are not registered with a GP, we have an in-house private GP practice you can use. Alternatively, we can suggest the most appropriate course of action for you to take, given your location and individual circumstances.

*Please note – for investigations such as X-rays and MRIs, a referral will be required. However, we may be able to arrange this for you through our on-site private GP.

    Make an enquiry

    Latest articles

    The latest news, insights and views from St John and Elizabeth Hospital.

    Find out what we’re doing to keep you safe, read expert articles and interviews with our leading specialist Consultants, learn more about common conditions and get your questions answered.

    05th July 2022

    What to expect as you recover from a stroke

    The sooner you begin therapy after a stroke, the more likely you are…

    first signs of mini-stroke

    24th May 2022

    The first signs of a mini-stroke and how to recover

    Having a stroke is a frightening experience, which over 100,000 people go through…

    home remedies for stomach pain

    05th May 2022

    Home remedies for stomach pain and when you should go to the hospital

    We all know what it’s like to have an upset tum or be…

    About hje hospital

    18th March 2022

    About St John & St Elizabeth Hospital

    Over the coming months, in planned phases, we’re opening the last few areas…

    health insurance

    18th March 2022

    Should you get health insurance?

    When it comes to paying for private healthcare, there are two main options…

    staying healthy while travelling

    17th March 2022

    5 tips for staying healthy abroad

    After the past couple of years we’ve had, you might be itching to…

    Private Cyst Removal

    20th January 2022

    What are cysts, and is cyst removal always needed?

    Cysts are a common skin condition, but what causes them, and do you…

    treatment after stroke

    18th January 2022

    Treatment after a stroke: What can you expect?

    A stroke occurs every five minutes in the UK. Post-stroke treatment is critical…

    medical professional looking into microscope

    12th January 2022

    Under the microscope: The many benefits of private healthcare

    Whatever your situation, there might come a point when you consider going private…

    shoulder pain

    11th January 2022

    What causes shoulder pain and what can you do about it?

    The shoulder is made up of various joints and tendons that allow a…

    gallbladder attack

    04th December 2021

    Are you having a gallbladder attack? Find out more about the causes, symptoms and treatment

    A gallbladder attack can happen at a moment’s notice and cause aggressive pain….

    overactive bladder

    02nd December 2021

    Constantly need to pee? How to treat an overactive bladder

    If you regularly get the feeling that you’ve “got to go”, you’re not…