What are rotator cuff tears?
A rotator cuff tear refers to damage to the tissues of the rotator cuff.
The rotator cuff is made up of four muscles and tendons that form a stabilising ‘cuff’ around the ball and socket shoulder joint. As well as stabilising the shoulder, the rotator cuff allows the shoulder to be one of the most highly mobile joints in the body. However, because of this mobility, the shoulder is susceptible to injury and pain.
The muscles of the rotator cuff are the supraspinatus (over the top), subscapularis (at the front of the shoulder) and infraspinatus and teres minor (at the back of the shoulder). The most commonly torn muscle is the supraspinatus muscle.
Tears may be caused by acute injury, degeneration or normal wear and tear. There is a certain rate of degeneration of rotator cuff in all people and it has been reported that approximately 70% of people by the age of 70 will have some form of rotator cuff tear.
What are the symptoms of rotator cuff tear?
The symptoms of rotator cuff tear are highly varied. Some patients may have rotator cuff tears with absolutely no symptoms – this is more common in an older age group.
When symptoms occur, they tend to be similar to impingement and tendinitis symptoms. These include pain and reduced movement.
Pain is frequently felt over the shoulder and down the outer and front part of the shoulder. The pain is often experienced at night and may cause difficulty with sleeping. Pain is worse when the arm is moved away from the body, and overhead activities can become increasingly difficult or impossible. Some patients who have rotator cuff tears for a number of years may develop arthritis in the shoulder and require joint replacement surgery.
What does your doctor look for?
Your doctor will take your medical history perform a physical examination that will include an assessment of how your shoulder moves and functions. Many people with rotator cuff tears have difficulty with overhead activities.
Acute rotator cuff tears, which usually occur in patients under 50 years of age with significant injury, often show a dramatic reduction in power and range of motion with high levels of pain. A degenerative type tear, which is often associated with subacromial impingement, tends to be much less painful and debilitating.
Specific examination of the different muscles of the rotator cuff is possible. Weakness in any of the four different muscles can suggest a tear, although the diagnosis is confirmed with further imaging investigations.
What investigations are needed?
Your doctor will request anX-ray of your shoulder, but you may also need to have an ultrasound scan to diagnose the rotator cuff tear.
If surgery is being considered, an MRI scan is required to assess the size of the tear and whether it’s repairable. This can also help predict the time of recovery and the likely outcomes of surgery.
How is a rotator cuff tear treated?
Treatment options for rotator cuff tears include:
- non-drug therapy (eg physiotherapy to maintain mobility and strengthen the muscles not damaged by the tear)
- medications (eg oral painkillers and anti-inflammatories; injections into the joint)
A full thickness rotator cuff tear is unlikely to repair without surgery. But if you don’t have symptoms and you’re able to use your shoulder without any difficulty, then surgery isoften not required, even with a large tear.
Surgery for rotator cuff tear
Surgery is recommended for:
- younger patients
- patients with acute tears
- patients who have not improved with non-surgical treatment
Rotator cuff surgery has several components: subacromial decompression, bursectomy, treatment of associated conditions (eg acromioclavicular joint arthritis and biceps tendinosis), and repairing the rotator cuff.
Our specialistsroutinely perform this surgery via arthroscopy, which is keyhole surgery. After trimming and mobilising the torn tissue, it is reattached to the humerus bone through a number of small incisions. This surgery is done under a general anaesthetic, but a regional anaesthetic is frequently given as well. You will need to stay in hospital overnight and then undergo post-op rehabilitation (link to rehab protocol).
Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.
Possible complications with rotator cuff surgery
The most common complication of rotator cuff repair is stiffness, which is sometimes referred to as a frozen shoulder. There is also risk of re-tear, which occurs most commonly 3–6 months after surgery. Many patients who have further tears of the rotator cuff tendon do not require surgery.