ROTATOR CUFF TEARSA guide to the symptoms and treatment for tears to the rotator cuff

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ROTATOR CUFF TEARS What causes a rotator cuff tear

and how do I know if I have one?A rotator cuff tear can result from an acute injury, such as a fall, or through more chronic wear and tear that erodes the tendon.

Rotator cuff tears are common, seen in over 30% of the population at age 70. Not all rotator cuff tears require treatment.

If your tear occurs through injury you may experience acute pain, a snapping sensation and immediate weakness in your arm.

When your rotator cuff tears, you will typically feel pain in the front of your shoulder that radiates down the side of your arm. Overhead activities, such as lifting or reaching, as well as sleeping on the affected side, may also be painful.

Some people experience weakness in their arm and find it difficult to perform routine activities such as combing their hair or reaching behind their back.

Can my rotator cuff tear get worse?A tear in your rotator cuff can get worse over time either through repetitive use or re-injury. Even after a minor injury, it is common for people with known rotator cuff disease to experience acute pain and weakness. This often represents an extension of the existing tear.

If you know you have a rotator cuff tear, increased pain and weakness may indicate that it is getting larger.

Diagram of a torn rotator cuff tendon

The rotator cuff is a group comprising of four muscles – the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles originate from the scapula (shoulder blade) and combine to form a ‘cuff’ over the top of your humerus (the bone in your upper arm).

The rotator cuff helps you to lift and rotate your arm. It also helps to maintain the alignment of the ball in its socket when you use your shoulder.

The most commonly torn and repaired rotator cuff muscle is the supraspinatus. Tearing tends to occur in the tendon which attaches the belly of the muscle to bone.

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What does surgery involve?Surgery for a rotator cuff tear is either arthroscopic (keyhole) or open.

The operation is usually carried out using a combination of a general and regional (switching off nerves to the arm) anaesthetic. In Arthroscopic cases there are two small incisions at the front /side and one at the back of the shoulder, each closed with a single stitch. Open surgery has a single incision closed with a stitch under the skin. Prior to discharge from hospital waterproof dressings are applied, so showering is possible the day after surgery. The stitches are removed after approximately 10 days.

The majority of patients stay in hospital a minimum of one night, which allows advice regarding care of the repair before leaving the hospital. Adequate pain control following surgery is very important and usually involves a combination of oral medications. A sling is worn for six weeks and in larger tears a wedge may be used to hold the arm out to the side for up to four weeks. Rehabilitation is under the guidance of the physiotherapists.

What are the long-term benefits of rotator cuff surgery? Rotator cuff surgery can provide:

� pain relief

� improved shoulder stability

� increased strength and range of movement

� increased ability to perform functional activities.

What does surgery involve?Surgery for a rotator cuff tear is either arthroscopic

The operation is usually carried out using a combination of a general and regional (switching off nerves to the arm) anaesthetic. In Arthroscopic cases there are two small incisions at the front /side and one at the back of the shoulder, each closed with a single stitch. Open surgery has a single incision closed with a stitch under the skin. Prior to discharge from hospital waterproof dressings are applied, so showering is possible the day after surgery. The stitches are removed after

The majority of patients stay in hospital a minimum of one night, which allows advice regarding care of the repair before leaving the hospital. Adequate pain control following surgery is very important and usually involves a combination of oral medications. A sling is worn for six weeks and in larger tears a wedge may be used to hold the arm out to the side for up to four weeks.

What are the long-term

increased strength and range of movement

increased ability to perform functional activities.

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How is rotator cuff damage diagnosed?After examining your shoulder to see if you have a tear, an orthopaedic surgeon may recommend an MRI or ultrasound scan to confirm the diagnosis.

Early diagnosis and treatment of a rotator cuff tear can prevent symptoms such as loss of strength and mobility from setting in.

Will I need surgery? If you are very active and use your arm for overhead work or sports, surgery is usually recommended. It is also recommended if the pain or weakness in your shoulder persists and does not improve with non-surgical treatment.

Surgery carries a small risk of problems, including infection, stiffness, neurovascular injury (damage to nerves and blood vessels) and failure to resolve the symptoms completely.

Can a rotator cuff tear be treated without surgery? Many rotator cuff tears can be treated non-surgically. Anti-inflammatory medication, steroid injections and physiotherapy can all help to treat symptoms of a tear. These treatments aim to relieve pain and restore strength to the shoulder.

Although most tears do not heal by themselves, satisfactory function can often be achieved without surgery.

MRI scan of an intact rotator cuff: the blue arrow points to the tendon; the red line shows where the tendon attaches to the humerus.

MRI scan torn rotator cuff; showing detachment of tendon from the humerus

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Notes

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How long is the recovery period? Physiotherapy plays a critical role in the non-surgical and surgical treatment of a rotator cuff tear. When a tear occurs, the muscles around the arm often atrophy, causing reduced mobility. Physiotherapy is necessary to regain strength and improve shoulder function.

While surgery repairs the damaged tendon, the muscles around your arm may remain weak. To succeed, the surgical procedure needs to be accompanied by a personal physiotherapy programme. Exact recovery timings depend on the tear size and the tissue quality found at the time of surgery.

You can usually drive approximately 8 weeks after surgery, and return to work in 4 weeks if your job is sedentary (typing may be difficult), and 4–6 months if it is manual. Your ability to resume leisure activities depends on the mobility and strength you regain in your shoulder after the operation. As a guideline; breast stroke swimming and non-contact sports after 3 months, golf and racquet sports (if non-dominant arm operated) at 4 months. Racquet sports (if dominant arm operated) and contact sports should not be considered for at least six months after surgery.

Arthroscopic photographs of a rotator cuff tear: before and after repair

Full recovery may take up to 9 months, but you should start to notice improvements within 12 weeks.

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King Edward VII’s HospitalFounded by Sister Agnes

Beaumont Street, London W1G 6AA Switchboard 020 7486 4411 enquiries@kingedwardvii.co.uk www.kingedwardvii.co.uk

Registered charity number 208944

Professor Roger Emery

020 7467 4552

barron.pa@shouldersurgery.co.uk

Mr. Peter Reilly

020 7467 4551

reilly@shouldersurgery.co.uk

Mr. R Andrew Sankey

020 7224 2733

secretary@andrewsankey.org

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