What is the rotator cuff?
The rotator cuff are 4 muscles and tendons which insert onto the top of the shoulder joint (humeral head) and which control shoulder movement and stability. Rotator cuff problems are the commonest reason to see a doctor for a shoulder problem.
How is the rotator cuff injured?
Younger patients who play throwing and overhead racket sports such as baseball, tennis and badminton, may be at risk of rotator cuff injury. Usually a small partial thickness tear may occur in the supraspinatus tendon which can progress with time to become a full thickness tear. Other causes of injury are a fall onto an outstretched arm. In older patients rotator cuff tears can occur without a sudden injury.
How will I know I have a rotator cuff tear?
You will have a painful shoulder and weakness of movement. Typically pain is on the outside of the shoulder, worse on raising the arm and at nighttime. There may be weakness in lifting the arm, or rotating your arm away from the body with the elbow bent.
Your doctor should examine you carefully and may request an Xray and MRI scan of your shoulder.
Do I need surgery?
I usually recommend a trial of non-operative management which may involve painkillers, physiotherapy and a steroid injection to the shoulder. Those who do not improve may benefit from surgery.
One important exception is a sudden full thickness tear following injury, of a previously normal shoulder, with inability to lift the shoulder. In this instance surgery is recommended, as delay may worsen the problem.
What happens during surgery?
You will be asleep during the operation, and I make several small keyhole incisions around your shoulder. I look at your shoulder using a camera (arthroscope). Using the small incisions, I place small screws (anchors) into the bone. Small ropes (sutures) are attached to the anchors, and are used to tie the torn rotator cuff into a secure and stable position. Surgery takes around an hour and your will wake up with your arm in a special sling (abduction brace).
What is the recovery period like?
Most people go home the following day, although some are well enough to go home the same day. The exercise program you are prescribed depends upon the severity of injury and quality of tissue. Most wear the abduction brace for around six weeks. Initially you will begin with passive exercises, and progress onto active motion exercises. Finally you will move onto light resistance and strengthening of your rotator cuff.
Immediate use of the elbow, wrist, and hand when sitting may be allowed for simple daily activities, such as holding a phone, whilst eating, and showering. You MUST keep the elbow on the side of the affected shoulder against your side at all times when the abduction brace is not in place.
At three months, most patients are allowed to use the shoulder for light activities above shoulder height. At six months, more vigorous activities are permitted. An extended period of time may be needed to regain strength and stamina in the affected shoulder.
Return to work is depends on your job, and can range from one week for office workers, to six months for jobs involving heavy overhead lifting or strenuous overhead sports. Following a supervised program of physiotherapy is extremely important to achieve a good result.
Dr Alan Cheung is a Consultant Orthopaedic Surgeon specialising in Sports Injuries such as torn ligaments and tendons, and cartilage injury in the knee, hip and shoulder, Adult Joint Reconstruction including total and partial Knee Replacement and Total Hip Replacement for osteoarthritis, and Robotic Surgery (Makoplasty, Navio and Robodoc systems). He has also received extensive training in trauma (fixing broken bones) and musculoskeletal tumour (bone cancer) surgery.