Rotator Cuff Tears

Rotator cuff tears: the rotator cuff is made of 4 tendons and the muscles to which they are attached.  It is responsible for rotating the arm, and it stops the humerus (upper arm bone) riding up against the acromion. Unfortunately, with age and use these tendons become worn and can tear, so this condition is often seen in older patients.

What causes them?

Rotator cuff tears, as we said above, can be caused by other conditions such as subacromial impingement syndrome, calcified tendonosis  or instability.  This type of tear is called a secondary tear ie it is the result of another shoulder problem.

Primary tears can be caused by an injury – either a fall onto the shoulder itself, or from lifting/catching an object that is too heavy – or by continually repeating a particular overhead movement, either during sport (throwing sports, swimming), occupational activities or daily life (cleaning windows, painting).  This type of tear can therefore be seen in patients of any age.

How do they feel?

Your shoulder will feel weak, with pain at the front of your shoulder radiating down your arm, particularly if you turn onto it at night.  If the tear is only partial, you may still be able to move your arm through a normal range of motion, but if the tendon tears completely it will make raising your arm out to the side impossible.  You may also feel as if it ‘catches’ when you move your arm.

Diagnosis

Your doctor will ask you about your medical history and make a physical examination. He may ask you to have an MRI (magnetic resonance imaging scan) which shows the condition of soft tissues.  He may also want X-rays of the shoulder to see if the tear is secondary, ie it has been caused by another shoulder problem such as bone spurs, calcium deposits or if the space under the acromion is unusually narrow.

Treatment – conservative

Your doctor may prescribe anti-inflammatory medication or cortisone injections.  He may also prescribe shock wave therapy and/or proper exercises to strengthen your shoulder muscles.f  In many cases, particularly with partial tears, this kind of treatment can be quite successful, though it may require time and patient’s compliance.

Treatment – surgical

Arthroscopic repair: your surgeon will make 2 or 3 small incisions around the shoulder through which he will insert a fibre-optic camera and the surgical instruments he needs.  First he will tidy the edge of the tear in the tendon.  Then he will insert small pins called suture anchors into the top of the humerus, pass a suture (stitch) through the edge of the tendon and then pull the tendon down attaching it to the bone by tying the suture round the suture anchor.  If necessary, he will also shave off a thin layer of bone from the base of the acromion to avoid the tendon getting pinched under it. 

If the tear is particularly serious, or there is a so-called massive rupture, the rotator cuff can’t be repaired. Your surgeon may perform an operation in ‘open’ surgery making a 7-8 cm incision to take a strip of tendon from elsewhere in your shoulder or back and attach it to the humeral head as a substitute of the rotator cuff.

Rehabilitation after surgery

For the first 3-4 weeks (depending on the severity of the tear) after the operation you will have to keep your arm immobilised in a brace.  However, right from the first day after surgery you must follow a physiotherapy programme of mostly passive exercises (the physiotherapist moves your arm for you).  After 3-4 weeks you can start active movement during your physiotherapy sessions, stretching, regaining your range of movement and very gradually re-building your muscles. After 12 weeks your physiotherapist will start giving you strenuous exercises to strengthen the rotator cuff and shoulder muscles, in order to prevent any damage in future.

When will I be back to normal?

You can return to office-work after a week or so, although if you do manual work you will have to wait at least 12 weeks depending on your recovery. You should be able to drive after 4 weeks.  You can start doing gentle sporting activity again at 6 weeks, although contact sports should be avoided for at least 6 months after surgery.