Advice after your nerve block for surgery
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Introduction
The aim of this leaflet is to give you a general understanding of your condition and what happens before and after your operation. It is designed to help you to prepare for your operation and after care once you go home.
Rotator Cuff tears
What is the rotator cuff?
The rotator cuff comprises four muscles that arise from the shoulder blade and insert into the top of the arm (humerus). These muscles are important for keeping the humerus centred in the socket on the shoulder blade during shoulder movement, particularly lifting, and lowering the shoulder and rotating the arm.
These four muscles are shown below:
Figure 1: Diagram to show the muscles of the rotator cuff.
What is a rotator cuff tear and who gets them?
As we age, our rotator cuff tendons are prone to wear and tear. This process sometimes causes pain, but for many of us this is a silent process causing no symptoms at all.
The supraspinatus tendon, which inserts right on the top of the head of the humerus, is the more commonly torn. It is more common for the tear to occur near the insertion on the humerus.
Occasionally acute trauma can cause damage to healthy rotator cuff tendons. This can often be due to a fall onto the shoulder. Shoulder dislocation in over 40-year-olds has a 40% risk of tearing the rotator cuff.
Rotator cuff tears are rare below 45 years old. To some degree, rotator cuff disease is a feature of ageing: a third of over 65-year-olds will have some kind rotator cuff wear and tear on MRI, but most of these people will have absolutely no symptoms. Most patients undergoing rotator cuff repair will be aged between 45 and 65.
Are there alternatives to Surgery?
Physiotherapy
This aims to restore balance and a smooth range of motion to your shoulder. Physios will guide you to strengthen your remaining intact rotator cuff muscles as well as focussing on your shoulder blade control and the large mover muscles of your shoulder that need to compensate for the weakness in the rotator cuff.
Steroid Injection (Cortisone)
The steroid injection can help reduce the bursitis (painful) element of rotator cuff disease. This can enable you to do your therapy more successfully. A single cortisone injection is extremely unlikely to exacerbate or cause a tear in the rotator cuff and it does not preclude future rotator cuff repair.
For degenerate rotator cuff tears (this is the majority of cuff tears), these non-operative measures should be tried before surgery is considered as several patients will improve enough to avoid surgery altogether.
Information about the procedure
What is a rotator cuff repair?
The repair of a damaged rotator cuff involves repairing the torn tendon, back onto the arm bone with sutures and bone anchors. The operation can either be done arthroscopically (key-hole surgery) or via an open incision, this will depend on the tear and other factors, and this will be discussed with you prior to the surgery.
In some cases, it will be difficult for the tendon to be repaired. In this case it is possible a partial repair or alternative reconstruction may be required. This can normally be predicted with preoperative imaging; however, the final decision may need to be made within surgery.
This procedure is usually performed as a ‘day case procedure’. However, some patients may need to stay overnight.
What do I need to do after my surgery?
Pain relief
A nerve block is sometimes used during surgery which means your arm may feel numb for 24 hours after your operation. It is normal to feel some pain as the block wears off and you will be provided with some painkillers to help with this. It is important to take your painkillers as prescribed to keep pain to a minimum, this will also enable you to move your arm as you have been instructed by your physiotherapist. If you are struggling with pain post operatively and it is impeding your ability to move your arm, please get in touch with 0300 614 4130 / 0300 614 4131.
Ice
Ice can be helpful to reduce pain/swelling. Protect your dressings from getting wet with a plastic bag. Wrap a bag of ice/frozen peas in a damp towel and apply for 10-15 minutes. This can be repeated every 3-4 hours.
Wound care
Following your operation, if you have had keyhole surgery, you will usually have 2, 1cm wounds, one at the front and one at the back of the shoulder, these will be covered with a dressing.
If you’ve had an open repair, your wounds will need to be kept clean and dry until they have healed (usually about 10 days). The nursing staff will provide you with more information about wound care on discharge.
At 2 weeks after your operation, you will attend a nurse physio/led clinic for your wound to be checked.
What is my recovery after surgery?
You will need to wear a sling for four-to-six weeks to protect your tendon repair, this will depend on the size of the tear, the quality of the tendon tissue repaired and how secure the repair is. Please take note of what movements are allowed and what to avoid.
Rehab Stages:
Phase 1 - Protection of your tendon repair in a sling. Restricted movements (4-6 weeks)
Phase 2 - Restore shoulder range of motion and control. (4-12 weeks)
Phase 3 - Strengthening and functional return (12-26 weeks)
You will have seen a physiotherapist before and after your operation. They will go through the exercises with you before and after your operation. You will also be given an appointment for outpatient physiotherapy within two to three weeks of your operation. Your physiotherapy appointments will be at regular intervals after your operation, your physiotherapist will guide your rehabilitation, progressing you when you are able and helping to regain your mobility in your arm (it is very important that you attend these appointments in addition to doing your exercises 3-5 times a day at home – they are key to the success of your operation).
By six weeks, many patients will be comfortable during light daily activities, but certain movements will still be restricted. Do not worry if you remain sore at this point: it can take a while longer to recover from this operation.
By six months, 85% of patients will feel their shoulder is better, although some patients take even longer to benefit.
Sleeping position
Sleep is important in your recovery and can be a bit of a challenge after an operation. Here are some tips that may help:
- Take your painkillers just before bed.
- You may find the following sleeping positions helpful. (Please note picture on the right is with body belt only)
When can I resume normal activities?
When can I return to work?
If you have a desk job you can return to work between 2 to 4 weeks, as long as your arm is supported in the provided sling. You can return to light manual work at 12 weeks, and it may take up to six months for return to heavy manual labour.
When can I drive?
You can normally return to driving at 6-8 weeks, depending on competence to control a car both for routine and emergency manoeuvres.
When can I return to sporting activities?
Your physiotherapist will give you guidance on this throughout your rehabilitation as your mobility and strength improves.
If you wish to return to swimming, you can start with gentle breaststroke from six weeks and freestyle from twelve weeks.
You may be able to return to contact sport from 5-6 months following the surgery, this will be guided by your physiotherapist and surgeon.
What happens before your admission to hospital?
You will be contacted by the pre-operative assessment clinic to assess your fitness for surgery. You will be given information regarding your surgery, and you will be able to ask questions.
Coming into hospital
You will be admitted to hospital on the day of your surgery. Please do not eat any food for 6 hours prior to your surgery; you can have a cup of tea or coffee with a small amount of semi-skimmed milk up to 2 hours prior to surgery and you can drink water until your surgery You may also receive a carbohydrate drink 2 hours prior to your surgery.
Time spent in hospital following surgery has reduced significantly over the last few years. Changes in surgery technique and support allows patient to go home on the same day or within 24 hours of their surgery. There are many advantages to being in your own environment, reducing the risk of complications and being in control of your own recovery.
Who is suitable for Day Case Surgery?
Not every patient having a rotator cuff repair is suitable for Day Case surgery. Patients must be medically fit and well, have friends and family to support them, have transport to and from the hospital and have the motivation to succeed. If you are not identified as a day case patient, you will stay overnight and go home the following day.
You will only be discharged home if it is medically safe to do so, you have someone at home with you and can manage safely. If there are any concerns, you will stay in hospital overnight and go home the following morning.
What are the risks and possible complications?
Rotator cuff specific complications
Arthroscopic & open shoulder surgery is very safe, and major complications are rare. Specific risks of rotator cuff repair surgery include:
Failure of tendon healing: The healing rate varies: most studies report healing rates of approx. 70%-90%. Healing is influenced by your age, your tendon tissue quality, the tear size and retraction and the repair itself. Failure to heal fully does not necessarily lead to a poor outcome, but as you would expect strength is better in those patients whose tendons heal fully. Some repaired tendons will re-tear in the future.
Stiffness /Frozen shoulder (3-5%): this might necessitate injection or further keyhole surgery to free up movement (capsular release and MUA)
Lack of benefit: approximately 10% of patients will not feel they have improved with their surgery. It will take at least 6 months to feel you have made a good recovery from this operation.
The risks of nerve injury, deep infection and major bleeding are very low (much less than 1 in 100 chance)
Uncommon (1-2%)
Infection: Infection around a new joint is a serious complication. It is therefore important that you do not have any infections prior to surgery, for example, skin, chest or urinary tract infection. Should you have an infection prior to your surgery, please inform the pre-assessment staff.
Wound healing problems: The scar will be over the front of your shoulder. Dissolvable sutures are typically used. It is rare for the wound not to heal nicely, but occasionally this may occur.
Anaesthetic risks: Modern surgical practice is very safe, but this surgery requires a general anaesthetic and normally a nerve block (to numb the whole arm for 18-24hrs to reduce peri-operative pain). There are small risks associated with anaesthetics and these risks are increased for those patients with significant pre-existing medical problems.
Rare (less than 1%)
Bleeding: This is usually small. It is rare to require a blood transfusion. The current transfusion rate in our unit is less than 1%. You may see bruising around the shoulder, the front of your chest and down to the elbow. This will subside and should not require any treatment.
Nerve injury: Whilst rare, injury to the nerves around the shoulder can occur during surgery. If nerve injury does occur, it may cause weakness of the shoulder or arm muscles. Normally, nerve injury is the result of a stretch to the nerves and will recover with time; but permanent injury can (very rarely) occur.
Questions
If you have further questions, do feel free to ask your surgeon, who can explain things for you. You will see them on the day of your surgery.
Useful Contacts
Heatherwood Hospital:
- Orthopaedic pre assessment 0300 614 7778 / 0300 614 7147
- Arthroplasty Nurse Heatherwood 07789927177
- Nurses Station Treetops Heatherwood 0300 614 4175
- Physio/OT Office Treetops Heatherwood 0300 614 4178
Frimley Park Hospital:
- Frimley Park Physiotherapy 07570 974390
- S2 Elective Ward Frimley 0300 613 3781 / 0300 613 3783
- Elective Helpline Frimley 0300 613 2556
Wexham Park Hospital:
- Ward 1 Wexham Park 0300 615 3010 / 0300615 3012
- Outpatient Physio Wexham 0300 615 3501 / 0300615 3500
- Wexham Park Physiotherapy 07717 199851
Contact us
If you have any queries relating to this information, please contact the Orthopaedics service.
About this information
Service:
Orthopaedics
Reference:
N/069
Approval date:
13 May 2025
Review date:
13 May 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.