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Dedicated to patient care, we utilise the latest arthroscopic and minimally invasive techniques for the management of all hip, knee and shoulder conditions; thereby facilitating the best recovery and outcome for patients from surgery.
Dedicated to patient care, we utilise the latest arthroscopic and minimally invasive techniques for the management of all hip, knee and shoulder conditions; thereby facilitating the best recovery and outcome for patients from surgery.

  • Shoulder Pain
  • Anterior Hip Replacement
  • ACL Reconstruction
  • Rotator Cuff Tear
  • Hip Arthroscopy

Rotator Cuff Tear

Rotator Cuff Tear

What is the rotator cuff?

The rotator cuff is made up of four small muscles and tendons that help rotate and stabilize the shoulder joint. Collectively they are used to perform overhead motions such as lifting our arms to comb our hair, dressing ourselves, or reaching for an item on a top grocery shelf. The most commonly involved rotator cuff tendon is the supraspinatus. The other three tendons are subscapularis, infraspinatus and teres minor. A fluid-filled sac (the subacromial bursa) lubricates the rotator cuff tendons allowing us to perform smooth and painless motions.

The shoulder joint is a ball-and-socket joint – the ball being the humeral head and the socket the glenoid. The functions of the individual rotator cuff tendons vary depending on where they attach to the humeral head. The supraspinatus tendon attaches to the top of the humeral head. When it pulls on the humeral head it elevates the arm. It is the most common tendon involved in rotator cuff tears. The subscapularis tendon attaches to the front of the humeral head and rotates the shoulder inwards. There are two tendons, infraspinatus and teres minor, attached to the back of the humeral head which help rotate the shoulder out.

What causes a rotator cuff tear?

Rotator cuff tears are one of the most common causes of shoulder pain in patients over the age of 40 years. It may occur with repeated use of the arm for overhead activities. In younger patients, an acute tear can also occur while playing sports or after an injury, such as a fall.

What are the symptoms?

Symptoms of rotator cuff tears usually involve pain over the front and top of the shoulder. This pain is usually exacerbated when trying to lift the arm above the shoulder. It can also radiate down the arm. Over time the pain may become more noticeable at rest and no longer goes away with medications. You may even have pain when you lie on the painful side at night.

The pain is often associated with weakness of the arm and limits simple activities such as dressing yourself or combing your hair. There may be stiffness, swelling, a crackling sensation, loss of movements, and tenderness in the front of the shoulder.

How is it diagnosed?

Your health professional will suspect a rotator cuff tear based on your symptoms and a thorough clinical examination. An x-ray is often performed to exclude underlying arthritis as well as diagnose any calcified tendons or bone spurs in the shoulder which can often cause related impingement in your shoulder.

To confirm the diagnosis an ultrasound or MRI is often required. MRI is preferred as it can more accurately determine the extent (complete or partial-thickness) and size of the tear. An MRI will also indicate the quality of the tendon and muscle involved in the tear, as well as how much the tear has retracted from its normal position. This is important in determining the best course of treatment for your shoulder.

What is the treatment?

Unfortunately rotator cuff tears do not heal by themselves. Some chronic tears however do respond to non-operative measures such as physiotherapy, as other muscle groups in the shoulder can be recruited to compensate for the torn tendon. Other non-operative measures include analgesia, avoidance of activities that aggravate the symptoms, as well as steroid injections that help calm down the inflammation in the shoulder.

For all acute tears and those chronic tears that haven’t responded to non-operative measures, surgery is often required. This is especially indicated if the rotator cuff tear is preventing you from performing activities of daily living such as dressing yourself or combing your hair.

Fortunately, most rotator cuff repairs can be performed arthroscopically (‘key-hole surgery’) through small 5-10 mm incisions allowing for a shorter hospital stay and quicker recovery. The torn tendon is reattached to its normal (anatomic) position using special sutures and anchors in the bone.

Should there be multiple problems in the shoulder, eg. subacromial impingement or biceps tendinitis as well as a rotator cuff tear, these can be addressed at the same time rather than undergoing separate procedures.

What is the recovery and rehabilitation after arthroscopic rotator cuff repair?

Although repairing the torn rotator cuff tendon is often straightforward, waiting for the tendon to heal directly back onto bone takes time, often a few months. Thus, completing a supervised shoulder rehabilitation program with a trained physiotherapist is crucial to your recovery.

Most patients are discharged the day following surgery. A sling is required for the first 4-6 weeks in order to protect the repair. It is advisable to avoid lying on the operated shoulder and using the arm to lift anything heavier than a coffee cup during this time. A tailored exercise program is required to assist in regaining your range of motion and strength.

What is the Recovery and rehabilitation after Arthroscopic Rotator Cuff Repair?

Although repairing the torn rotator cuff tendon is often straightforward, waiting for the tendon to heal directly back onto bone takes time, often a few months. Thus, completing a supervised shoulder rehabilitation program with a trained physiotherapist is crucial to your recovery.

Most patients are discharged the day following surgery. A sling is required for the first 4-6 weeks in order to protect the repair. It is advisable to avoid lying on the operated shoulder and using the arm to lift anything heavier than a coffee cup during this time. A tailored exercise program is required to assist in regaining your range of motion and strength.

FAQ

When can I drive after arthroscopic rotator cuff surgery?

You should not attempt to drive until you are out of your sling, your pain has subsided and you feel confident in your own ability. This is usually after six weeks. You should start with short journeys, initially with somebody accompanying you.

When can I return to work after arthroscopic rotator cuff surgery?

Your return to work will vary depending on the complexity of the procedure performed and type of work you are engaged in. Some people can return to office work within 2-3 weeks as long as you are not working with your arm away from your body. Certainly avoid any activity such as lifting or pulling for the first 3 months. Labour intensive work is not allowed for the first 6 months.

What are the risks of having arthroscopic rotator cuff surgery?

Complications are not common but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision regarding the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your surgeon.

What are the specific risks of shoulder arthroscopy?

Joint stiffness: There is a balance between keeping the shoulder in the sling to help the tear heal while at the same time moving your shoulder enough to prevent a frozen shoulder. Your physiotherapist will guide you on how to prevent stiffness.

Nerve or vessel damage: There are small nerves under the skin that cannot be avoided and cutting them may lead to areas of numbness in the front of the shoulder. This area of numbness normally reduces in size with time and does not cause any functional problems with the shoulder. Very rarely there can be damage to important nerves or vessels in the arm.

Recurrent tear of the rotator cuff or failure to heal: A repeat tear of the tendon after the repair can occur if you suffer another injury or don’t follow the post-operative rehabilitation and restrictions set out by your physiotherapist. Failure of the tendon to heal despite being repaired successfully can also occur based on the biology of the tear. If the tear has been chronic for many years, and the tissue quality is suboptimal, this can affect the final outcome.

Other general surgical risks include: Risk of infection and bleeding.

Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well-being and health.


Hip Knee Shoulder FAORTHA FRACSInternational Society for Hip Arthroscopy

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