Rotator Cuff Tears
A rotator cuff tear is a common cause of pain and disability among adults. In 2013, almost 2 million people in the United States went to their doctors because of a rotator cuff problem.
A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.
Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its joint and help the shoulder joint to move. The tendons can be torn from overuse or injury.
You will likely receive general anesthesia before this surgery. This means you will be asleep and unable to feel pain. Or, you will have regional anesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.
Three common techniques are used to repair a rotator cuff tear:
1.During open repair, a surgical incision is made and a large muscle (the deltoid) is gently moved out the way to do the surgery. Open repair is done for large or more complex tears.
2.During arthroscopy, the arthroscope is inserted through small incision. The scope is connected to a video monitor. This allows the surgeon to view the inside of the shoulder. One to three additional small incisions are made to allow other instruments to be inserted.
3.During mini-open repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Then during the open part of the surgery, a 2- to 3-inch (5 to 7.5 centimeters) incision is made to repair the rotator cuff.
• To repair the rotator cuff:
• The tendons are re-attached to the bone.
Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or material that dissolves over time, and do not need to be removed.
Sutures (stitches) are attached to the anchors, which tie the tendon back to the bone.
At the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what they found and the repairs that were made.
• What are Rotator Cuff Tear Symptoms
Your rotator cuff tears may be partial or full thickness tears.
You will will notice that your shoulder pain and weakness increases with the severity of your rotator cuff tear. More importantly, it is a reduction in your shoulder function that is important.
Partial rotator cuff tear may only present with mild shoulder pain, clicking during shoulder elevation and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back.
Full thickness rotator cuff tear will normally present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases the rotator cuff tear is so severe that a significant number of your pain fibres are also torn, which can make them less painful but very weak.
When you have a small rotator cuff tear you can often still raise your arm with or without pain. Moderate tears are usually very painful and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a large rotator cuff tear occurs you may find that you are unable to lift your arm at all.
• What is the Rotator Cuff
Your shoulder’s rotator cuff are a very important group of four small shoulder muscles that stabilise, control and move your shoulder joint.
When your rotator cuff muscles work in isolation they exhibit rotational motion at the glenohumeral (shoulder) joint, which is why they are termed the rotator cuff.
Your subscapularis, supraspinatus, infraspinatus and teres minor muscles are the four muscles collectively known as the rotator cuff.
• How is a Rotator Cuff Tear Diagnosed
Your physiotherapist or sports doctor will suspect a rotator cuff tear based on your clinical history and the findings from a series of clinical tests.
A diagnostic ultrasound scan is the most accurate method to diagnose the size and location of your rotator cuff tear. MRI’s may show a rotator cuff tear but have also been known to miss a tear. X-rays are of little diagnostic value when a rotator cuff tear is suspected.
• What is Rotator Cuff Tear Treatment
Small and medium size rotator cuff tears usually heal successfully with appropriate conservative management and physiotherapy treatment.
Unfortunately, large rotator cuff tears may require rotator cuff surgery if physiotherapy treatment fails to assist.
Early rotator cuff tear treatment is important. Delay will result in retraction of your rotator cuff tendon, which can make healing or rotator cuff repair surgery more difficult and less successful.The best rotator cuff tear treatment results occur when the rotator cuff injury is fresh.
• Rotator Cuff Tear Treatment
Rotator cuff tears are a common problem. Rotator cuff injury deteriorates further if you return to sport or work too quickly – especially if a thorough rehabilitation program is not completed. They are also regularly poorly treated by inexperienced shoulder practitioners.
Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents other shoulder injuries such as rotator cuff impingement or shoulder dislocation.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate rotator cuff tears and prevent recurrence.
• Rotator Cuff Repair Surgery
Rotator cuff repair surgery is considered for full thickness and partial thickness tears that do not heal with physiotherapy. Most shoulder surgeons will recommend at least six weeks of physiotherapy prior to contemplating rotator cuff repair surgery.
They do this due to the high percentage of success under the guidance of a shoulder physiotherapist and the knowledge that the recovery from rotator cuff repair will commonly take between six to twelve months of post-operative physiotherapy rehabilitation.
During rotator cuff repair surgery, your surgeon will attempt to sew your torn tendon back together. The best results occur when the tear is fresh rather than older tear.
Most rotator cuff repairs take approximately six months of rehabilitation to regain as full as possible range of motion, shoulder strength and function.
It is important to follow your physiotherapist and surgeon’s post-operative guidelines for your best outcome. In our experience, about 90% have an excellent outcome at 12 months post-operatively.
As with all surgery there are associated risks or complications. These can include infection, stiffness, blood clot formation, and nerve injury. The risks of significant joint stiffness are less than 5% and the risk of nerve injury is very low - approximately 1 in 10000.