Rotator Cuff Tears
What is the rotator cuff?
The rotator cuff tendons are a group of tendons that attach to the ball of the shoulder joint and are responsible for the fine movements of the shoulder joint.
What are rotator cuff tears and why do they happen?
A rotator cuff tear happens when the tendon (or tendons) tears away from its attachment on the bone. The most common type of tear (so-called “chronic tear”) is due to everyday wear and tear of the tendon as we age, and is not necessarily associated with an injury to the shoulder. The other, less common type of tear (acute tear) is typically associated with an injury to the shoulder, such as a dislocation. With an acute tear the shoulder was usually normal before the injury.
What are the typical symptoms of a rotator cuff tear?
Rotator cuff tears can produce pain in the upper outer arm (“referred pain”) rather than over the shoulder itself. The pain can radiate down the arm and can be associated with other symptoms such as pins and needles in the hand. Night pain with inability to lie on the affected shoulder is also a typical complaint. Certain movements of the shoulder may be painful and restricted, such as reaching above shoulder height, away from the body, or behind the back. On the other hand, some patients may have large rotator cuff tears that are not painful or symptomatic at all (some 25% of those over 65 years old). It is not yet clear why some patients are able to tolerate rotator cuff tears better than others.
What happens to the tendon once it has torn?
Once a rotator cuff tendon tears fully away from the bone, it never heals back to the bone. Therefore, once a tendon tears the best-case scenario, if left untreated, is that the tear will remain the same size. In roughly 50% of tears, however, the tear will progressively increase in size to a point where it may not then be possible to repair it.
What are the treatment options?
For chronic complete tendon tears, an initial period of treatment involving physiotherapy combined possibly with a steroid injection is typical. Repeated steroid injections are inadvisable since this can cause further damage to the tendon. If the symptoms fail to settle with these measures, surgery to repair the torn tendon is usually recommended. However, it may be preferential in young, active patients of working age to go for an early surgical repair if there is a proven full-thickness tear, since the tear has a strong likelihood of requiring repair at some stage anyway. Furthermore, the outcome of surgical repair is known to be more favourable with smaller tears than with larger tears, hence it may be preferable to repair earlier when the tear is smaller and the tendon is of better quality. Typically, an individualised, informed decision on the timing of surgery is made together with me, and is based on your symptoms, personal circumstances, examination findings, and an MRI scan.
Acute tendon tears are usually treated with early surgical repair since, in this scenario, the tendon rapidly retracts and degenerates, making subsequent repair more complex or impossible, and less likely to result in a good outcome.
What is the success rate of rotator cuff repair?
Rotator cuff repair using modern techniques and equipment is a highly successful procedure, resulting in good or excellent outcomes for the majority (80-90%) of patients. Whilst almost all patients should expect to see an improvement in their pain levels following this surgery, a significant improvement in range of movement in the shoulder is more challenging to predict. All patients will require extensive rehabilitation under the supervision of a physiotherapist for full improvement in their symptoms, which can take up to a year to achieve. A reasonable goal, however, would be that the operated shoulder is pain free and functional for most everyday activities by 6 months after the surgery