The rotator cuff tendons are the strong thick sheets that attach the rotator cuff muscles to the bone of the top of the shoulder (the humerus). They are involved in keeping the ball (humeral head) central in the shoulder socket (glenoid), while also being involved in all movements of the shoulder. The supraspinatus tendon (lifts the arm out to the side) and infraspinatus tendon (rotates the arm to the side) are most frequently involved in cuff tears.
Rotator cuff tears occur in the following situations:
- Acute tear – these happen suddenly as a result of a fall or trauma causing the tendon to pull off the bone or tear within its substance. This can be a complication of shoulder dislocations and other injuries.
- Degenerate tear – these happen as a result of age and activity related wear and tear, especially where there have been spurs of bone catching on the tendons. Sometimes a fairly innocuous event can be the final straw that leads to a tear in a weakened worn tendon.
What are the signs and symptoms of a rotator cuff tear?
Some rotator cuff tears occur as a normal part of ageing and remain symptom free. Those tears that occur after an accident or a fall tend to be very painful over the top and outside part of the shoulder. Movement makes the pain worse and some activities are no longer possible due to the pain. It is not uncommon to experience weakness on certain movements, especially when trying to lift the arm up, or perform activities over shoulder height.
Degenerate rotator cuff tears often occur on a background of niggling and discomfort that could have been present for months or years. Pain is often associated with certain movements. Weakness is often felt with tasks above shoulder height and strenuous activities, such as gardening or sports. Pain from both types of tears can disturb your sleep, especially when lying on the affected side. Clicking and cracking may be a feature of a rotator cuff tear, although pain-free clicking can occur in normal shoulders.
How are rotator cuff tears diagnosed?
Diagnosing a rotator cuff tear requires a careful questioning about any accidents or events that may have brought on the symptoms. The location and timing of the pain can give clues as to any underlying damage as well as any weakness noticed. A thorough examination testing all the muscles and tendons will often raise suspicions of a cuff injury.
When a tear is suspected, an X-ray can reveal any bone spurs or signs of arthritis. The best way to look at the tendons is through ultrasound or MRI scanning. These scans will better assess the tendons and soft tissues for any tears and muscle loss.
How are Rotator Cuff Tears Treated?
Many rotator cuff tears are asymptomatic and cause no problems. As such it is perfectly reasonable to “keep an eye on these” and not intervene unless pain or weakness arise. Rotator cuff tears will not heal on their own, but in many cases the tear will cause minimal symptoms, which can improve with simple measures.
For chronic and degenerate tears, rest, painkillers and physiotherapy can be very effective in managing symptoms. If, however, the patient has lost strength, has had symptoms for over six months, or has a large tear then it is worth discussing those issues with regard to further treatment options.
For acute rotator cuff tears in higher-demand or younger individuals, such as people involved in heavy manual jobs, overhead occupations (joiners, electricians etc), and sportsmen, it is worth considering surgical repair. In these cases a better healing rate is seen if the tears are repaired early and before they can extend and get bigger.
What does surgery involve?
The surgery can be done entirely using the latest keyhole techniques. It does, however, require either general anaesthesia (asleep) or a nerve block (awake while the shoulder and arm are temporarily made numb for several hours). Three to four small incisions are required to introduce the camera and instruments into the shoulder. A complete examination of the entire shoulder is made prior to repairing the torn tendons. The tendons are fixed back to the bone using special anchors, which are inserted inside the bone of the humerus. Any other abnormalities can be dealt with at the same time, such as shaving away any spurs of bone or dealing with other damaged tendons.
The surgery takes approximately 40 to 60 minutes. It is normal to be discharged from hospital the following morning after review by a physiotherapist. Usually small dissolvable stitches are used to close the keyholes. The wounds should remain covered for 14 days.
Partial thickness tears
Partial thickness rotator cuff tears should all trial exercise based rehabilitation under a physiotherapist for 3-6 months.
If non-operative treatment fails then Dr Shillington is able to offer the latest surgical treatment involving a bioinductive patch known as Regeneten. This patch is inserted through keyhole surgery and allows for an accelerated rehabilitation protocol when compared to traditional repair.
For more information see the link below and download the brochure:
What are the potential complications?
Complications from this type of surgery are uncommon but include pain and stiffness (in 5% of cases). These generally improve over the course of time. Re-tears of the tendon can occur, particularly if the tendon is very worn. These are more likely to happen with advancing age and in those who smoke or have diabetes, or in the case of massive retracted tears. Rare complications include infection, blood clots in the legs or lungs, nerve injuries and strokes.
What rehabilitation is necessary after Rotator Cuff surgery?
It takes a minimum of three months for the rotator cuff to heal back to the bone of the humerus. As such, the arm will be immobilised in a sling for the first six weeks. Recovery to complete normal function usually takes between 6 and 12 months.
Physiotherapy is absolutely essential during the rehab period to help minimise the chances of stiffness, but it is important to undertake only the exercises prescribed to avoid doing any damage to the underlying repair. Overdoing things in the first six to twelve weeks post surgery is a potential cause for damaging the repaired tendon.