Rotator Cuff Tears

Introduction

Rotator cuff tears are common and cause weakness, pain and loss of function in the shoulder.

The rotator cuff tendons are one of the key components of the shoulder.  The tendons can be subject to a considerable amount of wear and tear as we use our arms. This wear and tear can lead to weakening of the rotator cuff tendons . The rotator cuff tendons are also subject to degeneration with age.  An injury to these tendons can result in a weak, painful shoulder.  

Causes

Rotator cuff tears usually occur through areas of the tendon that were not normal to begin with and have been weakened by degeneration  and impingement (rubbing). The weakened rotator cuff tendons can be injured, or  torn , by an excessive force, such as trying to catch a  heavy object, falling or lifting a heavy object with the arm extended. This can occur even in a young person.   Typically a rotator cuff tear occurs in a late middle-aged person who has been having problems with the shoulder for some time before the acute event.  That person starts a lifting activity which exceeds the strength of the tendons, and the tendon tears suddenly, leaving weakness and an inability to raise the arm.  There may, or may not, be pain associated with this.

Symptoms 

Rotator cuff tears cause two main problems - pain and weakness.  In some cases there may be only a partial tear of the tendons, and you may have pain but can continue to move the arm in a normal range of motion.  In other cases a complete rupture of the tendon occurs, and you are unable to move the arm normally. A complete rotator cuff tear usually results in an inability to raise the arm away from the side of the body under your own power.

Most rotator cuff tears cause a vague pain  in the shoulder area and may result in a "catching" sensation when the arm is moved. The larger the tear in the tendon, the more weakness there is when trying to move the arm. Most people report an inability to sleep on the affected side because of pain in the arm.

Diagnosis

The diagnosis is usually made by the history and clinical examination.  A complete tear is usually obvious, but a small or partial tear can be difficult to diagnose.

X-rays may give clues as to whether there is a rotator cuff tear. An ultrasound can look at the tendons and give an indication of their condition, but ultrasounds can be quite inaccurate at times and may indicate tears where there are none and visa versa. 

Treatment

Initial treatment for a suspected rotator cuff tear is not always surgery. NOT ALL TEARS NEED SURGICAL REPAIR. A nti-inflammatory medication, mainly to control pain, and exercises to restore motion are usually prescribed first. As soon as pain tolerance permits, exercises and physiotherapy is begun to regain motion. While a true rotator cuff tear will not heal, this regime may restore motion and reduce pain to an acceptable level, thereby avoiding surgery.

A cortisone injection  may be used if you are still having pain after several weeks of treatment. After a reasonable time, if the pain is not tolerable or the motion of the arm is not acceptable, surgery may be considered.

Surgery to repair a tear in the rotator cuff tendons is usually necessary if there is a complete tear in the tendons resulting in an inability to raise the arm.  Surgery may also be necessary for a partial tear of the tendons - if the tear results in more discomfort and weakness than you are able to tolerate .

The surgery is usually done through a 6 cm inch incision on the side of the shoulder (depending on your build).  In most cases, repairing the tendons involves first removing any bony spurs in the shoulder.  Then, an area of the humerus (the upper arm bone) where the tendon was torn from is prepared for reattachment of the tendon.  The soft tissue is removed from an area of the humerus to form a raw bony area for attachment of the torn tendon with sutures or anchors.  The tendon heals to the bone over time and reattaches itself.

Surgery is usually done as a day procedure or an overnight stay where necessary. You will begin your physiotherapy as soon as possible after surgery.  The repair must be protected, mainly to keep the sutures from pulling out, but early range of motion exercises will lead to a quicker recovery (see: Aftercare Rotator Cuff).  During the period three to six weeks following surgery, the physiotherapist will begin more active exercises to begin regaining the strength in the rotator cuff muscles.

Recovery from shoulder surgery can be a slow process.  Getting the shoulder moving as fast as possible is important, but this must be balanced with the need to protect the healing muscles, tendons and tissues.  You can expect the process of recovery to take several months.

As mentioned earlier, a rotator cuff tear does not usually occur in a normal shoulder.   Most shoulders which have suffered a rotator cuff tear have other problems as well. The same problems that caused the rotator cuff tear have most likely affected the rest of the shoulder.  These can include acromioclavicular joint arthritis and impingement syndrome .  When surgery is suggested, the surgical procedure may have to address these conditions as well. 

Finally, not all rotator cuff tears are repairable.  Sometimes, the tendon has been torn for too long a period of time.  This can lead to the tendon and muscle contracting.   The muscle and tendon cannot be stretched enough to be attached back to where it was torn from.  In other cases, the tendon tissue has simply worn away, and what tendon remains is not strong enough to hold the stitches necessary to attach the tendon to bone.  In these circumstances, simply removing all the torn tissue and fixing any other problems in the shoulder (such as acromioclavicular  joint arthritis and impingement syndrome) may reduce your pain.  It will probably not increase the strength or motion of the shoulder.  It may actually decrease the motion.

Click here for post-operative instructions:  Aftercare Rotator Cuff  

Home | About Your Condition

The information on these pages is presented as a rough guide to help you understand your condition better. The information is in no way intended to be a comprehensive coverage of the subject. As all patients and their conditions are different, the treatment may vary from time to time. All patients are encouraged to take steps to ensure that they are as well educated about their conditions as possible. Other sources of information inc

Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977  F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au