Rotator cuff tears

Georgios Panagopoulos MD | Orthopaedic Surgeon

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the ball (head) of the humerus (upper arm bone) firmly within the shallow socket of the shoulder blade (glenoid). Further than keeping the ball in the socket, the cuff muscles help lift and rotate the arm. A rotator cuff tear is one of the most common causes of shoulder pain. The supraspinatus muscle is the one typically involved, followed by the infraspinatus, and the subscapularis muscle. A tear can be either complete (full-thickness), or partial.

What causes a rotator cuff tear?

Rotator cuff tears occur when tendons pull away from the arm bone. A tear may result from overuse/chronic wear & tear, or from an acute injury. Tears are common and increase with age. Tears of the rotator cuff may be incomplete (partial tears) or incomplete (full-thickness tears). Anyone can experience a rotator cuff tear, but people over 40 are more at risk. Tears can be caused by an injury to the shoulder, i.e., associated with a dislocated shoulder. However, most tears are so-called degenerative, due to chronic wear & tear. Bone spurs rubbing on the tendon (impingement syndrome) may eventually lead to a full-thickness tear. Also, repetitive use of the shoulder on the job or during sports may contribute.

What are the symptoms of a rotator cuff tear?

Symptoms usually develop gradually over weeks or months. The symptoms of impingement syndrome may include:

• Pain and weakness while raising your arm overhead
• Pain when lying on your arm
• Pain that worsens at night and disturbs your sleep
• Pain when lifting your arm overhead to reach something (i.e., from the cupboard)
• Difficulty performing activities of daily living

Partial & full-thickness tears often present with similar symptoms & treatment options are similar.

Diagnosis

Dr Panagopoulos will take a full history and perform a detailed physical exam, including measuring range of motion and strength. An x-ray will be ordered to look for arthritis or calcific tendonitis. An ultrasound in the office will be performed to look for tears. An MRI may be ordered to further clarify your anatomy and the extent of the damage, like tear size or degree of muscle atrophy.

Conservative treatment

Conservative treatment of rotator cuff tears includes:

• Rest
• Activity modification
• NSAIDS
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physiotherapy/home exercise program for strengthening and stretching exercises
• Steroid injection in the joint 

Rotator cuff tears do not heal on their own without surgery. However, many patients can improve functionally and have less pain by strengthening their shoulder muscles (deltoid strengthening, in particular). If symptoms fail to improve with non operative measures, the next option is surgery, with shoulder arthroscopy.

Surgical Treatment

Surgery is generally recommended if you have a full tear or your tear failed to respond to a 3-month trial of conservative management, including physiotherapy and injections. Most cuff surgeries can be performed arthroscopically. Dr Panagopoulos performs shoulder arthroscopy through 3 small incisions (4mm), through which he inserts a small camera and a variety of instruments. The bone spurs are trimmed, and the torn tendon is repaired to its anatomical position (footprint). Any other pathology encountered (biceps lesions, ACJ arthritis, etc.), is also addressed.

This is a day procedure. It is performed under general +/- regional anesthetic. You can go home the same day if you wish, just a few hours after the procedure.

During arthroscopy, a camera is inserted in the joint, in order to diagnose and treat any potential pain generators. This might include shaving off part of the shoulder blade (acromioplasty) and the collarbone (ACJ excision) to create a bit more space, fixing a diseased long head of the biceps tendon (biceps tenodesis or tenotomy) and fixing a rotator cuff tear with suture anchors.

Your arm will stay in a sling for 4 to 6 weeks after the procedure based on the size of the tear. Then you will start physiotherapy. Most patients regain shoulder motion within 3 months and strength within 6 months, but full recovery may take up to a year.

Recovery

Η φυσικοθεραπεία είναι εξαιρετικά σημαντική κατά τη διάρκεια της αποκατάστασης μετά από αρθροσκόπηση ώμου. Ξεκινάει με ήπιες ασκήσεις άμεσα μετεγχειρητικά. Στη συνέχεια ακολουθούν ασκήσεις για την αποκατάσταση του εύρους κίνησης & ενδυνάμωση. Ο χρόνος αποκατάστασης εξαρτάται σε μεγάλο βαθμό από το μέγεθος της ρήξης (μικρή – μεσαία – μεγάλη).

Exercise program

A specialised physiotherapist will follow our patients postoperatively, initiating an individualised rehabilitation protocol, based on patient needs and underlying pathology addressed. Exercise programs initially include active - assisted, passive & finally active exercises with resistance. Main goal is obtaining a full range of motion and regaining strength, ultimately returning in the pre-injury levels of activity.

Some tears are not repairable due to their size (massive tears), or due to poor quality of the tissue. These are the so-called irreparable tears. Those tears may necessitate another procedure, such as debridement of scar tissue without repair, a tendon transfer, or a reverse shoulder replacement.

Shoulder pain may be related to a rotator cuff tear, especially following a specific traumatic event. If you experience shoulder pain, it is important to see an expert shoulder surgeon.

Dr Panagopoulos will discuss with you all alternative treatment options during your office visit.

FAQs - Frequently Asked Questions