The “rotator cuff” is a collective term given to that group of inner muscles and inner tendons of the shoulder. It includes Supraspinatus , Infraspinatus and Subscapularis. (some authors like to include Teres minor too, but as a student and anatomy enthusiast for over 35 years , I think its both impractical and semantics)
The rotator cuff tendons can tear as one or as a group. The most common tears are supraspinatus and subscapularis.
Tears occur as 2 distinct age patterns- the younger patient aged 35-45 who has had a trauma/injury to suddenly tear the tendon; and the older (much more common) age group 50-90 who have slower, more insidious onset of tendon failure,, often without any injury event as the tendon tissue simple degrades, or degenerates, with every decade of life. (It is possible that as humans now live longer than ever before that the evolution of our tendons has not kept pace with the evolution of our lifestyles – viz computes, sports etc)
Rotator cuff pathology is by far the most common condition seen by and treated by shoulder specialists in all first world countries today. There is now a vast shared experience amongst surgeons worldwide and an explosion of knowledge has occurred over the last 25 years. It has been an exciting time to be a shoulder specialist and to be part of this wave of progress and technological change .
Rotator cuff surgery is now very common, very reliable and the results are usually good.
Dr Kirkham will assess each patient on their merits and comment upon both tendon quality and the repair strength. After that he will liaise with all 3 of patient, physio a d GP tp coordinate a detailed tailored plan aiming to restore function as soon as possible and as fast as safely possible.
One of my favourite sayings is that it takes 4 people to get one good result; The surgeon must be skilled, The physio must understand, the patient must cooperate with both ; but then finally (last, but not least) the patient needs a driver for a while and possibly that driver might also assist with dressing and showering in the early weeks after surgery.
Surgeons always differ in their techniques. Much of this is driven by preferences and comfort of their training. Having tried all the arthroscopic (keyhole) and the open techniques available or over 30 years, Dr Kirkham (like many others in Sydney) now uses a hybrid technique that combines arthroscopic surgery together with a small mini-open incision that allows for several advantages. It allows faster surgery which means shorter anaesthetics (with several advantages).
The anaesthetist may offer you a nerve block as well as a general anaesthetic (GA). The nerve block is typically performed under ultrasound control by your specialist anaesthetist just prior to your GA. The nerve block is to reduce not only post-operative pain, but also intra-operative blood pressure changes which then means less opiates, less nausea less time to recover from the GA. Either way you are asleep and unaware of any of this happening.