Rotator Cuff Tear

Dear patient the information provided to you is based on the evidence-based literature and our experience with the intention of providing insights into the rotator cuff tear, its symptoms and treatment available.

What is rotator cuff?

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. The shoulder joint is a ball and socket joint which allows large degrees of movements. The rotator cuff serves an important role in improving the stability of the shoulder and also coordinates with other muscles around the shoulder to move the arm.

Acute: it happens quickly when a person lifts a heavy object or over-stretches the shoulder

  • Chronic: it happens slowly as a result of wear and tear in the muscle’s tendon and can happen at any age, however it is the most common in late middle age.

What are the symptoms of a rotator cuff tear?

  • Pain
  • Weakness
  • Inability to lift heavy objects
  • Difficulty lifting arm above shoulder height
  • Difficulty sleeping on the affected shoulder
  • Stiffness in long standing cases

How is it diagnosed?

Clinical examination supported by scans [ultrasound and MRI]

What are the treatment options available?

Rest – will be helpful in cases of partial tears, followed by physical therapy.

Most patients get better with thorough physiotherapy

Painkillers for small duration

Physical therapy – postural correction of scapula humeral dynamics, strengthening the intact muscles to compensate the torn muscle

Cortisone injections – to be used with caution, as it can weaken the soft tissue and delays healing in patients who require surgical repair

Surgery – indicated for acute tears, chronic tears which do not get better with time, chronic tears in patients less than 50 years, massive tears with retraction

Consequences of untreated symptomatic rotator cuff tear is permanent pain and disability due to rotator cuff arthritis

What is done during surgery?

It is generally a key-hole or arthroscopic surgery where a tiny camera is inserted into shoulder joint through an incision which is smaller than 1 cm, 3 to 5 such incisions may be required to complete a surgery.

Here the torn muscle tissue is reattached to the bone bed where it belongs after optimal preparation of the bone surface to receive the torn tendon.

There are several techniques and suture configurations available

  • Single row
  • Double row

Surgeon will decide which is the required technique based on the duration, size of the tear and age of the patient. In general, smaller tears single row and in larger tears double row repairs will be done.

Different configurations of rotator cuff repair

After the operation

Your arm is supported in a sling straight after your operation to protect the repair. It is essential that you wear the sling day and night for 2-6 weeks (your Physiotherapist will advise you). The amount of time will depend on the size of the rotator cuff tear. This will be explained to you after your surgery. You can remove the sling to carry out your exercises and for washing and dressing only.

Rehabilitation is important if you are to get the most out of your shoulder after the operation. You should be given information about your first physiotherapy appointment before you leave hospital. The amount of physiotherapy you will need will depend on your individual progress and the level of activity you wish to return to.

Returning to work

The amount of time you have off work depends on your job. If you have a manual job, or one that involves lifting or overhead activities, you will not be able to do this for 8-12 weeks. Please discuss this with your Consultant or Physiotherapist.

Important things to remember following your rotator cuff repair

  1. Continue to wear your sling day and night as requested by your Consultant
  2. Do not lift your operated arm without assistance until it is allowed out of the sling
  3. Do not use the unoperated arm for any heavy manual work whilst in the sling