The rotator cuff are a group of muscles and tendons that surround the ball and socket of the shoulder.
They are responsible for 2 main functions: 1) Keeping the shoulder in joint 2) Move the ball around in the socket.
There are 3 main tendons called the
Supraspinatus – responsible for reaching upwards
Infraspinatus – responsible for turning the arm out towards the side
Subscapularis – responsible for reaching up behind your back
There are 2 types of rotator cuff tear
- Degenerate – these tears are a part of the ageing process which occur secondary to wear and tear over time. Very rarely a small bone spur will be pushing into the tendons from above causing it to wear. Over a period of time, as the wear and tear gets worse the degenerate tendon develops a hole/tear which in 50% of people will not cause any problems but in the other 50% will cause pain and symptoms. In a few instances it may take a small innocuous injury to cause convert a degenerate tendon into a tear.
- Traumatic Acute Tear – these tears occur after a definite injury. Patients report a specific event after which they report pain and weakness in the shoulder. They are unable to lift objects and have pain in side of the shoulder
which tends to travel down the arm. The pain can sometimes settle over time but many people are still left with ongoing problems.
Patients report pain and a dull ache around the side of the shoulder which moves down the side of the arm towards the elbow. Motion can be restricted with difficulty lifting the arm above the head especially with repetitive overhead activities. Sleep is generally disturbed with patients often unable to lie on the affected side at night with the pain causing people to wake up several times.
The rotator cuff may initially present with inflammation from ‘wear and tear’. Patients will report
• pain when lifting their arm above their head,
• difficulty reaching up for objects off high shelves,
• weakness when lifting objects and
• pain when reaching behind their back including reaching up for this bra strap.
• Disturbed sleep and
• Being awoken when lying on the affected side
Your treatment plan will be personalised to your individual circumstances. Everyone will be treated differently according to their occupation, demands and medical history.
Options include:
Physiotherapy
You will be referred to the physiotherapist who will tailor your rehabilitation to your requirements. They will concentrate on strengthening the shoulder whilst taking into account the dysfunction because of the rotator cuff.
Injection
An injection is an option if you are in pain. Whilst the injection does not ‘heal’ the tendon or cure the root of the problem, it gives patients good pain relief to enable them to start effective physiotherapy, allow people to sleep through the night and
perform daily activities. The injection lasts on average for 3 -4 months.
Surgery
In some cases the tear maybe irreparable. If this is the case then you may require a Reverse Shoulder Replacement. If the tear is repairable and you have exhausted non operative options then keyhole surgery is the final treatment
option.
Aftercare
Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will require removal at the hospital or your GP practice at 14 days.
You are moving your elbow, wrist and fingers immediately after the procedure. You start gentle movement of the shoulder within a few days. A sling is worn for anything from 3 to 6 weeks depending on how big the tear is and how many stitches are used to repair the tendon. You start heavy lifting at 3 months and extreme heavy lifting at 6 months.
Surgery for Rotator Cuff Tears is quite painful and many patients report and increase in pain for a few weeks after surgery. After 6 weeks the pain starts to settle. It can take from 6 weeks to 12 months to fully recover from the surgery. Every patient is different hence the large variation of rehabilitation time. You can continue to make improvements for 12 months after your operation and at this point will know the final outcome of your surgery.
Re-Tear of tendon
Sometime despite an extremely strong repair the tendon re tears. This is due to the poor quality of the tendon especially in degenerative tears.
Stiffness
Due to pain after surgery, patient may be reluctant to perform their exercises. If you do not gently rehabilitate your shoulder it can become stiff and you can develop a frozen shoulder.
Anaesthetic Risk
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
