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Commonly asked questions about Rotator cuff tears

Q:

What is the rotator cuff?

A:

The rotator cuff is made up of four muscles (subscapularis, supraspinatus, infraspinatus and teres minor). They work together to stabilize the ball (humeral head) in the socket (glenoid), a bit like a golf ball on a tee.

Q:

What are the symptoms of a rotator cuff tear?

A:

The most common complaint is pain. Sometimes the pain may be minimal at rest but substantially worse during particular activities, such as reaching overhead, changing a light bulb, reaching to the back from behind and sleeping on the affected shoulder. In addition, when the size of the rotator cuff tear is large, there is shoulder weakness as well as loss of movement in the shoulder.

Q:

I was lifting something heavy and felt something ‘pop’. Since then, I have noticed a lump in my upper arm, although it is relatively painless, is it serious?

A:

The lump is known as the Popeye deformity and is caused by a rupture of the biceps tendon. It is invariably associated with a rotator cuff tear and a visit to your doctor is advisable.

Q:

What causes rotator cuff tears?

A:

This may be due to a variety of reasons:

  • Normal wear and tear - rotator cuff tears are very common with increasing age due to poor blood supply. Studies have shown that more than 50% of healthy individuals aged over 60 will have evidence of a rotator cuff tear
  • Fall onto the arm
  • Heavy lifting
  • Repetitive strenuous overhead activities – this is very common in people employed in the building trades eg plasterer, builder, carpenter

Q:

What tests are helpful in making the diagnosis?

A:

These include:

  • X ray
  • Ultrasound scan
  • MRI scan

Ultrasound scan is as sensitive as MRI in diagnosing rotator cuff tears but more specific Ultrasound has the added advantage of being a dynamic test whereby the rotator cuff can be seen to move with the arm in real time. Furthermore, ultrasound avoids some of the problems associated with MRI scanning including claustrophobia and interference with metal hardware, pacemaker etc

Q:

Can I prevent the problem from getting worse?

A:

One should minimise excessive overhead activities as well as avoid working through pain, as this could worsen the problem by enlarging the size of the tear.

Q:

Can rotator cuff tears heal on their own?

A:

No, a complete rotator cuff tear does not heal spontaneously. Surgery is required to reattach the torn muscle back to bone.

Q:

How soon does treatment need to be given?

A:

The results of surgery are best when the size of the tear is small and when the torn edge of the muscle has not retracted far. When the torn muscle is neglected, the torn edge of the muscle becomes further and further away from its attachment to bone and the muscle belly progressively atrophies alongside with fatty infiltration of the muscle. Once these changes have occurred, they are not reversible. In essence, treatment is best given as soon as possible.

Q:

What treatment options are available?

A:

The treatment options include:

  • Non steroidal anti-inflammatory drugs
  • Hot packs
  • Physiotherapy – This can help to maintain your current range of movement and prevent stiffness. Physiotherapy cannot however mend the torn tendon.
  • Steroid injection – This has anti-inflammatory action and can give effective pain relief for a short duration of time. However, it will not mend the underlying torn tendon. Special care should therefore be taken if it is used for long periods, as it can have serious adverse effects on the tendon and bone.
  • Surgical repair

Q:

What does surgery involve?

A:

Surgery involves arthroscopic (key hole) surgery in which two to three little stab incisions (about 0.5 to 1cm each in size) are made around the shoulder. Through these arthroscopic portals, the camera as well as a variety of surgical instruments is inserted into the shoulder. The undersurface of the acromion bone which can sometimes rub against the surface of the rotator cuff is firstly smoothened with a burr. The torn tendon is then fixed back onto bone (humeral head) using suture anchors which are 5mm screws with an eyelet at the end through which sutures pass through. The suture material is made of an ultra-high molecular weight polyethylene and multiple sutures are required to achieve a secure repair.

Q:

How long do I need to stay in hospital for this operation?

A:

This will depend on the time of your operation. It will either be a day case procedure or sometimes overnight stay

Q:

When can I return to activity and sport?

A:

The exact period may vary from person to person but generally speaking, once the shoulder has regained full range of movement and normal strength compared to the opposite shoulder, you can safely return to sports.

Arthroscopic view of a large rotator cuff tear

Arthroscopic repair of rotator cuff

The information on this website does not replace medical advice. If you have a medical problem please see your doctor or consultant.