There are four rotator cuff muscles which elevate and rotate the arm. These are supraspinatus, subscapularis, infraspinatus and teres minor. Their tendons blend with the shoulder capsule and form the rotator cuff. The main role of the rotator cuff muscles is to stabilise the shoulder joint, but they also contribute to the movement of the arm. Rotator cuff injuries are a result of normal wear and tear or can occur as a result of overuse and trauma.
What are the risk factors for rotator cuff injuries?
Rotator cuff injuries are common, and their incidence increase with age. It is common for people over the age of forty to develop a rotator cuff tear and the incidence will reach 33% by the age of seventy.
People involved in activities that require repeat overhead movements like painters or carpenters are more likely to develop a rotator cuff tear. Smokers and diabetics have a higher risk of developing a tear. This may be related to a lack of blood supply to the rotator cuff tendons.
Rotator cuff tears happens regardless of the level of activity a person does. Many people with tears can be asymptomatic while others have troubling symptoms that require medical attention and even surgery.
A traumatic injury to your shoulder (a fall or a road traffic accident) can increase the risk of developing a tear. Tears that occur as a result of trauma are best treated with surgical repair.
What are the symptoms?
If you have a rotator cuff tear you may have pain over the shoulder and on the lateral aspect of the upper arm. Pain can wake you up at night and may be made worse by reaching away or moving your arm at the back. In acute tears you can experience weakness or even inability to lift your arm up.
Will I need any scans?
Rotator cuff tears are best seen on MRI scans. Large tears can be also seen on ultrasound. Usually, an X-ray is taken to exclude other pathologies like arthritis or large bone spurs.
Can I avoid surgery if I have a tear?
Painkillers and anti-inflammatory tablets may help reduce pain. Partial thickness tears can be treated with physiotherapy. A steroid injection may be useful to reduce the pain and allow better exercising.
Are there any complications of rotator cuff tears?
A full thickness tear will not heal and may progress to a larger tear. Without treatment cuff tears may lead to permanent loss of motion or weakness and may accelerate the degenerative changes in your shoulder joint.
What is the treatment of a rotator cuff tear?
Many rotator cuff injuries that develop in time can be treated with physical therapy and injections. Partial thickness tears may benefit from biologic treatments with PRP or stem cells. Usually, symptomatic tears are treated surgically in patients under 70 years old. Any tear that occurs as a result of trauma in an active patient is better treated with surgical repair.
What is an arthroscopic cuff repair?
Surgery (arthroscopic rotator cuff repair) is reserved for patients that fail to improve with conservative treatment. If you have had an injury, then prompt surgical treatment is likely to result in the best outcome for your shoulder function.
The aim of the surgery is to reattach the torn tendon to its insertion on the humerus to reduce pain and restore function. This is performed as a keyhole (arthroscopic) procedure as a day case under general anaesthesia. Small incisions are made around the shoulder to allow insertion of a camera and instruments into the joint. The procedure starts with a look around the shoulder to confirm the diagnosis and identify any other pathologies that can be missed during clinical evaluation. Specially designed anchors are inserted into the bone. The anchors have sutures attached that are used to reattach the torn tendon to the bone.
What is the success of the rotator cuff repair?
The success rate (pain relief and return to normal shoulder function) is about 90 percent although it can take up to nine months to recover fully.
Are there any risks?
Any surgical procedure carries risks including infection, bleeding, nerves or vessels damage, stiffness and incomplete relief of symptoms. Occasionally, despite that the tendon has been repaired back to the bone, it fails to heal and re-tears.
What is the recovery after surgery?
You should expect to be in a sling for up to 6 weeks depending on the size of the tear and the quality of the tendon. This protects your shoulder and gives your rotator cuff time to heal. You can remove the sling and use your arm gently. Pendular and circular exercises are usually allowed. More complex exercises will need the supervision of a physiotherapist and should be started after the sling is removed. Heavy lifting should be avoided for 4-6months. Physiotherapy is essential after the operation, to encourage restoration of movement, rehabilitate the muscles back to normal function and ensure you are making good progress.
When can I return to normal activities?
Return to work depends on the nature of the job and your speed of recovery. You can return to office work when you feel comfortable to do so. You will be unable to drive for at least 6 weeks until after the sling is removed. Return to sports is allowed at 4 months but a full recovery may take 9 to 12 months.
Are there any ways to enhance the results of surgery? A small tear has a chance of healing of 95% while a large tear heals in about 73% of cases. Massive tears fail to heal in over 50% of cases. Depending on the size of your tear Mr Negru may advice the use of platelet rich plasma at the end of the surgical procedure or insertion of a subacromial balloon to protect the repair during the recovery period.
What if my tear is unrepairable?
Mr Negru is an expert arthroscopic surgeon in shoulder and elbow surgery. If your rotator cuff tear has a poor predicted outcome due to size, age or length of time since the tendon has been torn you may be a candidate for a superior capsular reconstruction, tendon transfer or a reverse total shoulder replacement to restore the function of your shoulder. Mr Negru regularly performs these procedures with excellent outcomes.