A torn rotator cuff will weaken your shoulder. This means that many daily activities, like washing/combing your hair or getting dressed, may become painful and difficult to do.
The shoulder is a ball-and-socket type joint made up of three bones:
The head of the humerus fits into a socket (called the “Glenoid”) in the shoulder blade. A group of muscles and tendons keeps the shoulder centred in the shoulder socket. These muscles are called the rotator cuff. They cover the head of humerus and attach it to your scapula. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa allows the rotator cuff tendons to move freely when you move your arm in all directions.
The biceps muscle (in front of your upper arm) helps you bend your elbow and rotate your forearm. It also stabilizes the shoulder. The biceps muscle has two tendons that attach it to bones in the shoulder.
The Glenoid (socket) is lined with soft cartilage structure called the labrum. This tissue helps to stabilize the head of the humerus into the shoulder socket.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object or falling on an outstretched hand.
There are two main causes of rotator cuff tears: injury and degeneration.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
Most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, therefore people over 40 are at greater risk.
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Overhead athletes are especially vulnerable to overuse tears, particularly tennis players and swimmers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.
Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.
The most common symptoms of a rotator cuff tear include:
Acute tears, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.
Tears that develop slowly due to overuse will also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.
Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
Your doctor will test your range of motion by having you move your arm in different directions.
After discussing your medical history and symptoms, your doctor will examine your shoulder. He will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder and arm strength, your doctor will have you move your arm in several different directions and do several specific tests.
Your doctor will also examine your neck to make sure that the pain is not coming from a “pinched nerve” and to rule out other conditions, such as arthritis.
(Left) Normal outlet view x-ray.
(Right) Abnormal outlet view showing a large bone spur causing impingement on the rotator cuff.
Important: If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time. Chronic shoulder and arm pain are good reasons to see your doctor. Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.
The goal of any treatment should be to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider:
In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.
Nonsurgical treatment options may include:
The disadvantages of nonsurgical treatment are:
Arthroscopic Rotator Cuff Repair - http://www.youtube.com/watch?v=lKk0B8_gD80
Your doctor may recommend surgery if:
There are a few options for repairing rotator cuff tears. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.
Surgery to repair a torn rotator cuff involves re-attaching the tendon to the head of humerus. A partial tear, however, may need only a trimming or smoothing procedure called a debridement. A complete tear within the thickest part of the tendon is repaired by stitching the two sides back together.
There are a few options for repairing rotator cuff tears. Advancements in surgical techniques for rotator cuff repair include less invasive procedures. While each of the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon to heal.
You may have other shoulder problems in addition to a rotator cuff tear, such as osteoarthritis, bone spurs, or other soft tissue tears. During the operation, your surgeon may be able to take care of these problems, as well.
The three techniques most commonly used for rotator cuff repair include:
Dr van den Berg does most of his rotator cuff repairs arthroscopically which leads to less pain, shorter hospital stay and the ability to address all underlying conditions of the shoulder with minimal soft tissue damage.
During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery. All-arthroscopic repair is the least invasive method to repair a torn rotator cuff.
During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint.
(Left) An arthroscopic view of a healthy shoulder joint. (Center) In this image of a rotator cuff tear, a large gap can be seen between the edge of the rotator cuff tendon and the humeral head. (Right) The tendon has been re-attached to the humeral head with sutures.
Surgery is performed to suture the torn tendon ends to the bone. During surgery, Dr. van den Berg also will remove any inflamed bursa or bone spurs that would delay tendon healing.
You will receive a general anaesthesia and an injection of a local anaesthetic around the nerve that goes to the shoulder. This lasts 4-24 hours and will help decrease your pain after the surgery.
Following surgery you will awaken in the recovery room with your arm in a sling. You will remain in the recovery room for 30-40 minutes until fully awake and will stay overnight in the hospital to ensure no medical problems develop. Most patients go home the next morning.
During shoulder arthroscopy, a small camera, called an arthroscope, is inserted near the shoulder joint through a small (usually 5-10mm) incision. The arthroscope is attached to a video monitor to allow Dr. Van den Berg to look inside your joint.
Instead of making a large incision, Dr. Van den Berg uses three small (5-10mm) incisions. Through one incision, he inserts the arthroscope to look inside your shoulder. He inserts special instruments that allow the removal of scar tissue and bone through the other two incisions. Dr. Van den Berg will then insert small plastic/metal screws (called “suture-anchors”) into the shoulder.
There are sutures attached to the eyelets of the screws. We use special instruments to weave the sutures through the torn tendon. The screws are inside the bone and you cannot feel them. They do not have to be removed. The screws will not set off airport sensors.
(Left) The rotator cuff muscles and their tendons.
(Right) Typical location for a rotator cuff tendon tear.
(Left) The suture anchors are inside the bone. The green and white sutures are ready for the repair.
(Right) The sutures have been placed through the torn tendon. The sutures hold the tendon in position while it heals to bone.
Physiotherapy plays a vital role in getting you back to your daily activities. A personalized physiotherapy program will help you regain shoulder strength and motion. You will be referred to a dedicated shoulder physiotherapist with years of experience in treating all kinds of shoulder problems.
After surgery, therapy progresses in stages. At first, the repair needs to be protected while the tendon heals. To keep your arm from moving, you will most likely use a sling and avoid using your arm for the first 6 weeks. How long you require a sling depends upon the severity of your injury.
Even though your tear has been repaired, the muscles around your arm remain weak. Once your surgeon decides it is safe for you to move your arm and shoulder, a therapist will help you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist supports your arm and moves it in different positions. In most cases, passive exercise is begun within the first 6 weeks after surgery.
After 6 weeks, you will progress to doing active exercises with the help of your physiotherapist. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program. Expect a complete recovery to take several months. Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery. Although it is a slow process, your commitment to rehabilitation is key to a successful outcome. Full recovery may take up to a year but results and outcomes are generally good or excellent.
Surgery to repair a torn rotator cuff is almost always successful in alleviating shoulder pain. Returning strength to the shoulder is more difficult to guarantee. This type of surgery is successful about 85-95% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Rotator cuff repair for a tear from a acute injury works best if it is done within a few weeks of the injury. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.
Factors that can decrease the likelihood of a satisfactory result include:
Very large tears [greater than 2 in. (5 cm) or involving more than one rotator cuff tendon] often cannot be repaired. Grafting and patching procedures are possible, but they are not much better at restoring strength than debridement and smoothing, which are less risky and require less rehabilitation.
Less active people (usually those older than 60) with confirmed rotator cuff tears that do not cause pain, significant weakness, or sleep problems can safely go without surgery unless symptoms get worse.