Rotator cuff tear
The ‘rotator cuff’ refers to the small tendons within the shoulder joint. Tendons connect bone to muscle, and a tear in one can cause significant pain and loss of movement in the joint. A tendon tear can be a result of an injury or accident, or as a result of aging, and the type of tear may affect the treatment suggested.
Age-related tears: We know that as we get older, our tendons begin to change their inner structure and consistency. This can lead us to experience chronic degenerative tears that develop very slowly and without any trauma.
Acute tears: These are the result of an injury to the shoulder or a ‘wrenching’ injury, where there has been a significant pull on the joint. Often, somebody will come to see me after they have had an accident and are now complaining of pain, weakness and perhaps some bruising around the shoulder.
Before any treatment can be given, it’s important to know exactly what the problem is. When I first meet with you at Sulis Hospital Bath, I will carry out a full examination of your shoulder in order to accurately assess the cause and extent of the problem. As part of this, I will move your arm around into different positions in order to test the resistance of all the different muscles and muscle tendons within and around the shoulder in isolation. Diagnostic scans, such as an MRI or ultrasound, will confirm a diagnosis of rotator cuff tear, and these can both be carried out at Sulis Hospital Bath.
Treatment options for rotator cuff tears
There is a bit of debate about when rotator cuff tear repair surgery should be carried out, and this will be affected by your age as well as the type and severity of the tear.
Treating acute tears – If you are under the age of 60 and have obvious symptoms as a result of a rotator cuff tear, you should really be advised to have surgery to repair it. Where your symptoms are very obviously affecting your work, effective treatment becomes more of a pressing issue.
It’s fair to say that some people do choose to start with a conservative approach to treatment – rest, physiotherapy etc. - in order to try get the shoulder working properly again. These approaches can certainly be of benefit, although for an acute tear an early repair will usually be more successful overall.
Rotator cuff tear surgery tends to be done nowadays using a type of keyhole surgery known as arthroscopy. It is carried out under general anaesthetic as a day case, meaning you will be able to return home the same day. The surgery involves repairing the tendon and reattaching it securely to the bone. This gets everything working properly again and the results are good; probably 80%-90% of people are pleased with the outcome of surgery.
It is important to note that the recovery and rehabilitation does take time. You will need to be in a sling for three weeks after the surgery, and then rehabilitation under the guidance of the Sulis Hospital Bath physiotherapy team will take place. It can take 9-12 months to regain as much function as possible in the shoulder.
The worst part is probably about the first 4-6 weeks after the surgery, when things are healing but still not quite right. By this stage, it can be quite frustrating for people. However, it is worth sticking with it. From my own experience, and I’ve now carried out 5,00 shoulder surgeries, 90% of people say they are pleased they had the surgery and are satisfied with the result.
Treating chronic tears – Treating chronic tears can be a bit more of a challenge, especially as we know a large number of people of a certain age will have tendon tears. 30% of people over 60 will have a full thickness rotator cuff tear but be blissfully unaware of it as they don’t have any symptoms from it; the tear is compensated for by the other tendons. Probably about 60% or so of people over the age of 80 will have tendon tears like this that they are just not aware of, and this is a natural age-related wear phenomenon.
As we get older, we need to weight up the risk-benefit ratio for tendon repair surgery as any surgery has increased risks with age. For my older patients, I tend to suggest we try conservative approaches first; possibly some gentle physiotherapy or even a steroid injection into the joint to reduce any acute inflammation. This can help to reduce the pain. Having said this, if you are still symptomatic after being treated with the conservative approach, then certainly we could consider surgical repair through the arthroscopic approach.
Future treatment options for rotator cuff tears
Sometimes rotator cuff tears, both chronic and acute, can be quite large. We know that if we try to repair these larger tears arthroscopically, they historically have a high rate of failure. To try to navigate this problem, we are now moving into using tissue grafts from donors to help aid the repair of these larger tendon tears.
Certainly, there is a lot of promising research looking into slightly different ways of repairing these tendons. This will hopefully benefit those patients in the future who would otherwise be facing long-term pain from an irreparable tear. These advances are still under investigation, but the results are certainly looking encouraging and I am keeping my eye closely on things to ensure you will always be provided with the best possible treatment available.