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Also Known as: Tendon Tear
WHAT IS IT?
The rotator cuff is a group of tendons that connects the four muscles of the
upper shoulder to the bones (see
Anatomy). The strength of the cuff allows the muscles to lift and rotate the
humerus (the bone of the upper arm). The tendons run under the acromion (part of
the shoulder blade) where they are very vulnerable to being damaged. This can
lead to a tear resulting in a painful, weak shoulder. A tear may result suddenly
from a single traumatic event or develop gradually. When the tendons or muscles
of the rotator cuff tear, the patient is no longer able to lift or rotate his or
her arm with the same range of motion as before the injury and/or has
significant pain associated with shoulder motion. The pain is also very common
at night, often radiating down the arm.
As people age, it is normal for the rotator cuff tendon to wear and degrade,
however only a small proportion of people develop pain and weakness that
requires treatment.
CAUSES:
1. Injury, especially while trying to lift or catch a heavy object
2. Overuse, especially after a period of inactivity
3. Poor blood supply to an area of the cuff (which occurs with increasing age)
4. A fall on an outstretched arm
5. A gradual weakening of the tendons of the shoulder, often associated with
impingement
PREVENTION:
o Avoid excessive overhead activities.
o Strengthen your shoulders and do not try to play or work through the pain.
TREATMENT:
1. Painkillers and anti-inflammatory medications
2. Physiotherapy - keeps your shoulder strong and flexible and reduce the pain
and weakness
3. Cortisone steroid injections - reduces inflammation and control the pain
4. Surgery is required -
a. If the tear follows an injury
b. When pain and weakness is not improved with injections and physiotherapy
- The goal of any surgery is to relieve the pain and improve the shoulder
strength. This requires a long period of physiotherapy in addition to the
surgery.
- Surgery may be done Arthroscopically (keyhole) for small tears or Open for
large tears.
- Some tears are too large to repair and then Arthroscopic Debridement may be
performed to relieve the pain.
Rotator Cuff Repair
A complete rotator cuff tear will not heal. Complete ruptures usually require
surgery if your goal is to return your shoulder to optimal function.
A rotator cuff repair involves stitching the torn tendon back onto its
attachment to the arm bone (Humerus). This may be performed either through
keyhole surgery (Arthroscopy) or open surgery, using sutures and bone anchors.
For Interactive Animations see
Interactive Surgery - go to
[Shoulder] then [Impingement & Rotator Cuff Problems] and [Fully Torn Rotator
Cuff].
GENERAL ADVICE
You should not eat or drink anything after midnight the night before the
procedure.
You will usually be in hospital for 1 to 3 days. If the operation is done by
keyhole surgery you will be able to go home the same day (daycase)
A doctor/physiotherapist will see you prior to discharge and you will be
taught exercises to do and given further advice to guide you through your
recovery.
Your arm will remain in a restrictive sling
for at least 3 weeks. This means
that you will be unable to use the arm throughout this time and you will be
unable to return to work. For more details on
Living with a Shoulder Sling CLICK HERE
The length of time that you will be off work will depend on your job but expect
a minimum of 3 weeks for minor tears, increasing to possibly 6 months if work
involves heavy duties.
Out patient physiotherapy will be organised for when you leave hospital and may
well continue for some considerable time.
You will be guided through the rehabilitation programme by your physiotherapist.
It is of the utmost importance that you stick strictly to this programme.
09/11/2003 |
