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Rotator Cuff Tear

Other popular names

Who does it affect?

Usually people over the age of 40 years old as the rotator cuff tendon wears and degrades over time. Occasionally, particularly after an injury, tears may happen in younger patients.

Why does it happen?

As people age, it is normal for the rotator cuff tendon to wear and degrade.  The rotator cuff becomes weak and prone to rupture or tear. A fall or wrenching injury can then result in complete rupture of the tendons which leads to pain and weakness of the shoulder.

Symptoms

The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bones. The strength of the cuff allows the muscles to lift and rotate the humerus (the bone of the upper arm). The tendons run under the acromion (part of the shoulder blade) where they are very vulnerable to being damaged and can lead to a tear resulting in a painful, weak shoulder.  A tear may arise from an injury or develop over time.  When the tendons or muscles of the rotator cuff tear, is it no longer possible to lift or rotate the arm with the same range of motion or strength as before.  The pain is also very common at night, often radiating down the arm as far as the elbow. It is unusual for pain to go beyond the elbow down to the hand.

Diagnosis

Frequently the diagnosis can be made after taking a history of the problem and after examining the shoulder. It is usual for an x-ray and a scan to be used to diagnose this condition.  Usually this is done via ultrasound but may be via an MRI scan when information on muscle and tendon quality is required prior to surgery.

Non-surgical treatment

Physiotherapy may be used to minimise the pain, strengthen the shoulder and attempt to restore a wider range of movement.

Pain-killers and anti-inflammatory drugs will also be offered. 

Therapeutic steroid injections may be used to reduce inflammation and provide pain relief.  These are only performed once or twice and may be done via ultrasound guidance. In general if surgery is being considered, then a steroid injection is not recommended.

Often pain and weakness is not improved with physiotherapy or injections and at this time you will be offered surgery. 

A complete rotator cuff tear will not heal and will require surgery if you want to return your shoulder to normal function.

Surgical treatment

Surgery is carried out as a day case procedure under general anaesthetic. Sometimes, a nerve block is used as well, to provide pain relief.

A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone (humerus) and is normally performed arthroscopically (keyhole surgery).

Post-surgery rehabilitation

You can go home soon after the operation.  You will return from theatre wearing a sling. This is worn for about six weeks.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The bulky dressing will be removed after 1 day.  The wound is cleaned and redressed with a simple dressing. The stitches are removed at about 12 days. 

Return to normal routine

Keep the wound dry until the stitches are out at 12 days.

You will need a course of physiotherapy after surgery. It is very important to follow the specific rehabilitation regimen that the physiotherapist follows. Failure to do so could mean that the repair of the tendon is not successful.

The final result from surgery may take up to 12 months. This does depend on the condition of the shoulder before surgery and the extent of the torn tendons and the rotator cuff muscles.

There is clear evidence that smoking reduces the healing rate of the tendon. You are, therefore, advised not to smoke to give your shoulder the best chance of healing and recovering following surgery.

Return to driving:

You are advised that you will not be able to drive while your arm is in the sling. Usually, it is a few weeks after the sling has been removed before you can return to driving. You will be advised of this after your surgery.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 12 weeks. Your activities will be limited particularly for the first few weeks while the sling is being worn. You will be given advice on your own particular situation.

Risks

Overall over 97% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).

Specific risks:

• Failure to completely resolve the symptoms.
• The tendon may re-rupture. There is clear evidence that the larger tendon tears re-rupture more frequently following repair surgery than small tears.

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