What is the rotator cuff?
The shoulder, as we know from our shoulder instability blog, is a large, complex joint! It is a ball and socket joint made up of the humerus (arm bone) and the glenoid cavity (fossa) of the scapula (shoulder blade). The rotator cuff is made up of four muscles and associated tendons (which join the muscle to the bone) and their primary function is to stabilise the shoulder joint and help lift and rotate your arm.
How does the rotator cuff get injured?
The rotator cuff tendons work hard throughout our life and are involved in most actions of our upper limb. As a result, injuries to the rotator cuff tendons are common. Tears can occur in the tendons due to trauma or general use over time as we age. Acute, traumatic tears often occur due to an accident or injury where the patient describes the exact moment of injury (falling on an outstretched arm). Degenerative tears can occur over time and often the pain comes on gradually without a distinct injury/event in mind. Things like repetitive use, lack of blood supply and bone spurs often contribute to the likelihood of degenerative tears. The type of tear (cause, location and size) along with the patient’s symptoms (pain, weakness, disability) helps us decide whether conservative or surgical treatment is required.
Type of Tears
The supraspinatus tendon is often the most common tendon we see tears in however, other parts of the rotator cuff tendon can also be injured. In particular, accidents or injuries can result in tears to multiple tendons at the same time. Degenerative tears in particular can often begin as fraying which over time can progress to full or partial tears.
There are two types of tears
- Partial tear. This type of tear is also called an incomplete tear. It damages the tendon but does not completely sever it.
- Full-thickness tear. This type of tear is also called a complete tear. It separates all of the tendon from the bone.
What are the symptoms of a rotator cuff tear?
The most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific movements
- Weakness when lifting or rotating your arm
- Crepitus or crackling sensation when moving your shoulder in certain positions
Generally, acute traumatic tears usually result in severe pain and some patients may also experience a ‘tearing’ or ‘snapping’ sensation. Degenerative tears by their nature generally present with shoulder pain and/or dysfunction and weakness. Usually, the pain starts of mild and progresses until it becomes increasingly difficult to perform daily tasks without difficulty. It is important to note that not all rotator cuff tears result in pain and dysfunction. Some patients may find out they have a rotator cuff tear incidentally on MRI findings although, they may be able to function day to day without much difficulty. Diagnosis is usually made by a combination of a physical examination plus an MRI of your shoulder.
How are rotator cuff tendons treated?
Treatment of rotator cuff tears is primarily directed by the patient’s symptoms and function combined with physical exam and MRI findings. There are two different streams of treatment which our team may recommend depending on your findings.
In most cases, we try to exhaust conservative treatment options before progressing to surgical treatment. Your level of disability combined with the size, type and location of tear will guide Prof. Moran in making this decision. Non-surgical treatment options include physiotherapy, rehabilitation, anti-inflammatories and cortico-steroid injections. Many patients will have tried one or more of these options guided by their GP/Physiotherapist before visiting our office to discuss surgical treatment options.
In cases where conservative treatment has failed or where Prof. Moran’s examination recommends surgical treatment, the tear can be repaired through surgical means. Factors that help us decide whether surgery may be appropriate include the duration of symptoms, size of the tear, activity/sport, level of weakness/dysfunction/disability and whether the tear was traumatic or degenerative in nature.
The majority of rotator cuff surgery is performed through arthroscopic (key hole) means and the procedure itself takes about 1 hour. Patients are generally in hospital for one night and wear a sling from approximately four weeks. Our clinical team reviews all patients at approximately 2 weeks after the procedure to check the wounds, advise on weaning off the sling and guide the rehabilitation team. Every patient is reviewed at this time point to ensure an individualised treatment and recovery plan. It takes the best part of 4-6 months to recover fully which is heavily influenced by the patient’s compliance with the rehabilitation programme.