ROTATOR CUFF TEARS
If you click on the link above you can download my patient information booklet. It has detailed information with colour pictures. The following is a summary of the important information.
The rotator cuff is part of the muscle that helps lift up your arm. It tends to wear out as you get older - more than half of all humans have a hole in the tendon by the time they die. Luckily enough rotator cuff tears may not cause too many problems and some people may have no symptoms whatsoever.The rotator cuff may also tear due to acute injuries and this may include injuries at the workplace. However, it is important to know that there is almost always some underlying wear in the tendon and any injury may be the 'straw that breaks the camel’s back'.
If you do have symptoms from a rotator cuff tear you will usually notice pain in the shoulder. This is worse with lifting your arm above your head and may be particularly bad with activities such as driving, dressing, reaching to put something on a high shelf and lifting things at arm length - even things as light as a kettle. Pain may be particularly bad at night and often you will not be able to lie on your shoulder. If the tear becomes large you may notice weakness and if it becomes very large you may find that you are unable to lift your arm.
Many rotator cuff tear can be treated without surgery. Avoiding activities that make the pain worse is important as well as taking pain killers such as Paracetamol or anti-inflammatory tablets. An injection of cortisone can be very helpful but will not actually heal the tendon. Unfortunately, the cortisone is good at treating bursitis but can actually do some damage to the tendon. We therefore recommend a maximum of three injections.
If your symptoms are severe and last for many months, surgery is often required. A subacromial decompression is performed and this is covered in the 'Bursitis / Impingement Syndrome' section. The rotator cuff is then repaired; this is either done as arthroscopic (keyhole) surgery or as an open procedure where a cut is made in the skin. I will choose the technique that best allows a strong repair. The tendon is reattached to bone by using small anchors that screw into the bone and have sutures coming from them. The sutures are then tied into the tendon to hold it onto the bone. Alternatively, a large stitch is used that passes through both the bone and the tendon and gives a strong repair.
Healing of the rotator cuff is an extremely slow process; I often tell patients that it is like the roots of a tree growing through concrete. I think this gives a good idea of how slow the healing is. Because the healing is so slow you will need to be in a sling for six weeks after surgery and you will be unable to lift up your arm during that time. You will have some very simple exercises which a physio will go through with you.
Six weeks after your surgery you can come out of the sling and begin gentle day to day activities such as eating your dinner, combing your hair, brushing your teeth and driving. Even at that stage your arm will be very stiff and sore and it will take some months before you start to feel that the operation has been successful. Full recovery takes as long as 1-2 years!
I will give strong pain killing tablets to you after surgery and the use of these is covered in the patient booklet.
Although rotator cuff repair has a slow recovery period it has excellent results and 95% of people are very happy with the long-term outcome.
As with any surgery complication can occur and they are dealt with in a separate section.