Rotator Cuff Tears
The rotator cuff tendons are four tendons that are responsible for elevation and rotation of the shoulder. They surround the ball of the ball-and-socket joint at the front (subscapularis), the top (supraspinatus) and the back (infraspinatus & teres minor). The most common location of a tear is in the top within the supraspinatus. As the tear gets bigger it extends towards the front or the back into the other tendons.
New rotator cuff tears as a result of an injury often present with the same clinical picture; pain and weakness. Shoulder impingement is a clinical diagnosis. The pain is usually felt down the side of the shoulder and can extend towards but not beyond the elbow. Pain comes on when the arm is lifted away from the side of the body (painful arc), over head and behind the back. With time, the shoulder may become increasingly stiff with reduced range of movement due to pain.
X-rays or other scans are not routinely required but may be requested to rule out other conditions or prior to considering a steroid injection if there is concern regarding the possibility of a rotator cuff tendon tear.
Management without surgery
Most rotator cuff tears are degenerative and small and can be managed very successfully with activity modification, pain killers, physiotherapy and injections. Physiotherapy is the mainstay of treatment to strengthen the remaining tendons around the shoulder and improve the control of your shoulder. The other modalities, including injections, are simply to enable you to be pain free enough to carry out your exercise regime to achieve your goals.
Management with surgery
Some rotator cuff tears are acute (new tears due to an injury) or larger. Acute tears are normally offered surgery and the outcome is often better the sooner they are repaired. In addition, larger degenerative or longstanding tears may not improve clinically with physiotherapy and may require surgery. The most common procedure performed for this condition is named, “arthroscopic rotator cuff repair”. Through keyhole surgery, the tendon is cleared to healthy edges and the bone prepared to receive the tendon which is attached firmly to the bone with anchors. Occasionally, the tendon quality is poor requiring the addition of a patch of tissue to strengthen the repair, (GRAFTJACKET).
The operation is normally performed under general anaesthetic and a nerve block to provide good pain relief after the surgery. It can also be performed with you completely awake just with a nerve block. This means you can watch the surgery taking place on the screen, you won’t feel drowsy or sick afterwards and you’ll be discharged very quickly after the customary tea and toast! Let us know if you would like to consider awake surgery as only certain lists are set up to provide this service.
The surgery is performed as a day case procedure, unless it is not safe to do so. It is common to have swelling because of the surgery and the wounds are stitched. Your arm will be placed into a shoulder immobiliser sling and the physiotherapists will tell you what you are allowed to do with your shoulder. At 10 days following surgery, the stitches and dressings are removed at your GP practise. Physiotherapy will guide your rehabilitation and let you know when your sling can be removed; usually between 3 and 6 weeks following surgery depending on how big the tear was and how strong the repair was.
Risks include bleeding, infection, pain and stiffness in the shoulder.
Specific risks with this operation are
- Failure to get rid of your pain (10-15%)
- Nerve injury (<0.1%)
- Further surgery required if fails to work
85-90% of those undergoing rotator cuff repair will be significantly improved by 3 months following surgery and will continue to improve thereafter.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery within the UK and Europe with many renowned surgeons.
or Call 0113 388 2067
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