Rotator Cuff Tear

Background

The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). The rotator cuff is comprised of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons that attach from the scapula to the humerus.

The muscles of the rotator cuff help stabilize the shoulder and enable you to lift your arm, reach overhead, and take part in activities such as throwing, swimming and tennis.

The rotator cuff can tear as an acute injury such as when lifting a heavy weight or falling on the shoulder or elbow. The shoulder is immediately weak and there is pain when trying to lift the arm.

Diagnosis / Symptoms

  • Shoulder pain which may radiate down the arm.
  • Pain is worse when the arm is lifted overhead or twisted.
  • Weakness when raising the arm
  • In extreme cases, you may have pain while sleeping

The diagnosis can be confirmed by magnetic resonance imaging (MRI) or an x-ray taken after dye has been injected into the shoulder (arthrogram).

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Treatment Options

A torn rotator cuff due to an injury is usually best treated by early surgical repair. The rotator cuff can also wear out as a result of degenerative changes. This type of rotator cuff tear can usually be repaired but sometimes the tear may not need to be repaired and sometimes cannot be repaired. However, if the tear is causing significant pain and disability, surgery may be the best treatment to relieve pain and improve shoulder function.

If a torn rotator cuff is not repaired, the shoulder often develops degenerative changes and arthritis many years later. This type of arthritis is very difficult to treat and the longstanding tear in the rotator cuff may be irreparable.

Most rotator cuff tears can be repaired surgically by reattaching the torn tendon(s) to the bone. It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be long depending on the size of the tear and the quality of the tendons/muscles.

This technique involves placing an anchor with sutures (thread) in the bone and re-attaching the torn tendon back down to the bone. The suture is tied and functions to hold the torn tendon in place until the tissue heals reestablishing the tendon-to-bone connection.

It takes several months for the tendon to heal, and during this time, forceful use of the shoulder such as weight lifting and raising the arm out to the side or overhead must be avoided.

After surgery, you will use a sling and a large pillow that holds your arm out to the side of your body for 4-6 weeks. You can remove the sling 4 to 5 times a day for gentle pendulum motion exercises.

Results and Risks of Surgery

The success of rotator cuff surgery depends on the size of the tear and how long ago the tear occurred. Usually, a small tear has a good chance for full recovery. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation is completed. If the tear occurred a long time ago (several months or longer) it can be difficult or sometimes impossible to repair. Most patients achieve good pain relief following repair regardless of the size of the tear unless the tear is massive.

Shoulder pain is usually worse than before surgery during the first 3 to 4 weeks after surgery, but then gradually the pain lessens. This is especially true while trying to sleep at night. It can take up to a full year to regain motion and function in the shoulder. In addition to the general surgical risks, shoulder stiffness and loss of motion are potential problems after rotator cuff repair. Re-rupture of the repaired rotator cuff is possible if too much force is placed on the repaired tendon before it is fully healed. Nerve and muscle injury and infection are infrequent complications.

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Further Reading

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