Treatment For Rotator Cuff Tear

What is it?

The rotator cuff is a ring of four muscles and tendons which surround and stabilise the shoulder joint. A rotator cuff tear is the term used to describe damage to this group of muscles and tendons.

Why does it occur?

Age plays an important role in the development of rotator cuff tears. As we age, the rotator cuff tendons weaken, increasing the chance of a tear. Tears are more common in adults over the age of 40.

Repeated movements of the hands and arms in the overhead position can also accelerate weakening of the cuff. Overhead activities including painting can cause development of tendonitis, which may progress to a complete tear in one of the tendons.

Tears are also common in athletes who use repetitive overhead movements, including swimmers and tennis players. In some cases, a tear can be sustained from a direct impact e.g., a fall from a bicycle or a dislocation of the shoulder.

What are the symptoms?

You may experience pain, primarily on the top and in the front of your shoulder. Pain can also occur at the side of your shoulder, and is usually worse with any activity that forces you to reach above the level of your shoulder. You may have difficulty moving your shoulder, causing progressive stiffness and weakness.

Rotator cuff tears can also cause inflammation in the small sac of fluid (bursa) that surrounds the joint, known as bursitis. This can feel like a mild popping or cracking sensation, which can cause pain and discomfort when sleeping on the affected shoulder.

How is it diagnosed?

A detailed history and examination will take place to determine the extent of the injury. Diagnosis is confirmed using an ultrasound or MRI scan.

How is it treated?

Non-surgical treatment

Many rotator cuff tears can be successfully managed with pain relief, physiotherapy exercises and steroid injections. These measures are suitable for those with low physical demands on their shoulder, and those who do not want to have surgery. In many cases, the loss of function following a small rotator cuff tear can be slight and does not interfere with day to day life. Steroid injections can be very effective in relieving pain, as the hydrocortisone acts as a powerful anti-inflammatory. Following an injection, the joint should be rested for 24 hours and the sticky plaster should remain on to prevent anything from entering the injection site.

Platelet-rich plasma (PRP) injections are being used more and more where conservative treatment is not effective. A solution is extracted from the patient’s own blood, rich in growth factors which aid tendon healing.

Surgical treatment

When a rotator cuff tear begins to interfere with normal activities, arthroscopic or keyhole shoulder surgery may be necessary to restore function to your shoulder. Shoulder arthroscopy is used as an alternative to making large incisions. Advanced technologies have made it possible to use 4mm (1/4″) incisions, allowing the surgeon to perform the procedure accurately and safely. These small incisions lead to less pain and scarring after surgery, which means faster recovery time and being discharged from hospital the same day.

A telescope is used with a fibre optic light source attached to a camera. The image from the camera is projected on to a high resolution monitor with great magnification. A full inspection of the joint and the bursa is performed to confirm the diagnosis and to check for any further problems. Special surgical instruments are then used through further small incisions to perform the operation.

The rotator cuff surgery can only be performed in patients with healthy tendon tissue. If the tendon has become too worn, it tends to have a poor blood supply, and there are not enough healthy cells to heal the tendon back on to the bone. If this is the case, a Subacromial decompression may be a favourable option.