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Rotator Cuff Tear - Shoulder Injury

Rotator cuff tears are a common cause of shoulder problems. They occur following trauma but can also occur spontaneously or from excessive load on the shoulder. They are more common in the older age group as part of the problem lies in the fact the tendon is weak due to degeneration.

The pain is typically nocturnal or when the shoulder is loaded, running from the shoulder down into the upper arm. There is associated weakness especially when lifting the arm. Stiffness is not common.

They can be diagnosed clinically when you are seen as the muscle is weak. The shoulder is often wasted and you can often see this around the shoulder blade if you look in the mirror. Scans are needed to confirm which muscles are damaged, how big the tear is and most importantly how much of the muscle is wasted which is attached to the tendon. They are sometimes associated with a biceps rupture leading to a ‘popeye’ deformity.

Diagram showing Rotator Cuff Tear

The diagnosis is confirmed using either an ultrasound or an MRI. This helps us plan treatment long term.

The pain can be managed with simple injections. This are often used to confirm the source of pain even if surgery is required later. Physiotherapy has a significant role to play in the recovery of these injuries. It is a common misconception that because it is torn it must be repaired. Here we aim to manage the pain and the secondary weakness. If the pain settles with an injection and the physiotherapy strengthen other muscles then nothing further needs to be done.

If this fails then surgical repair is an option. Keyhole surgery is the mainstay of treatment now as the results are as good as open surgery without the increased risks. This is a day case procedure done under general anaesthetic. You will be likely in a sling for a period of between three and six weeks. During this time you will work closely with your therapist gradually increasing the movement. The initial recovery period is 2 to 3 months where there will be restrictions to your day to day activities and work. You will likely not be driving for at least 4 to 6 weeks depending on progress. After this time your muscles strength will return and the shoulder will continue to improve all the way up to six to 12 months post-surgery.

The success rate is in the order of 80% improvement of 80% of your symptoms. The resolution of pain is usually more reliable than the improvement of weakness. This is way we often plan surgery based on the ongoing pain you are suffering. There are some small risks of infection, clots and a frozen shoulder. The cuff can re-tear in time and ultimately, as the condition is degenerative the symptoms do usually return, although you can expect a good few years of pain relief.

In a younger age group of patients, with high energy injuries, the pattern of tearing is different and surgery can be indicated from the outset.

Other options of pain management can be considered such as nerve blocks. These are best undertaken by experts in this field and we can point you in the right direction if this is the best course of treatment for you.

Other procedures for this condition such as graft surgery and even reverse shoulder replacements should only be considered in severe ongoing pain after other treatment techniques have been tried. They have no long term follow up of results and it is difficult to predict what the future might be with this type of surgery.

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