A rotator cuff tear can worsen over time if left untreated.
It is important to get it properly diagnosed and seek the right treatment.
Learn to identify the signs of a rotator cuff tear and understand your
treatment options.
Your rotator cuff comprises a group of 4 muscles and tendons
around your shoulder joint. Its purpose is to stabilize the joint and enable
you to lift and rotate your arm.
What is a rotator cuff
tear?
A rotator cuff tear is a tear in the muscles or tendons that
form the rotator cuff. This can happen slowly over time through repetitive wear
and tear (degenerative tear), or suddenly from a fall or from lifting something
heavy (acute traumatic tear).
When you are diagnosed with a rotator cuff tear, your doctor
will want to know the degree of the damage – partial or full tear – before
advising on the appropriate treatment. A partial thickness tear, commonly
referred to as a partial tear, refers to how deep the tear is in the tendon. A
full thickness tear is when the tear goes through the tendon. Such tears are
typically diagnosed via magnetic resonance imaging (MRI).
What are signs you may
have a rotator cuff tear?
A rotator cuff tear that is not treated will get worse over
time, which will make treatment and recovery more challenging. If you are
unsure if your shoulder pain is just a strain or something more serious, look
out for any of the following symptoms, and get your shoulder checked by a
doctor without further delay.
- Pain when you move your arm in a certain way or when you lie on it
- General weakness in your shoulder
- Inability to lift the weights you can normally lift
- Difficulty raising your arm
- Feeling or hearing popping noises when you move your arm
Will you require
surgery?
If you have a partial tear of less than 5mm in size, it is likely the injury will heal without surgery as long as you follow the correct rehabilitative exercises. Your doctor will prescribe pain killers and anti-inflammatory medication to help in the healing process. You will be referred to a physiotherapist to go through exercises you can do at home. These exercises are designed to gradually allow your shoulder to heal, and help it return to normal function. Your physiotherapist will also advise you on what you can and cannot do so that you don’t damage your rotator cuff further during the healing process.
If physiotherapy is ineffective or you have a full tear, surgery will be your best option to stitch the torn tendon or reattach it to the bone.
What surgery options are there?
Depending on your injury, your surgeon will recommend one of the 4 types of surgical procedures available:
Arthroscopic tendon repair. Your surgeon will make tiny incisions in your shoulder and insert a tiny camera (arthroscope) and tools through the incisions to fix the tear or reattach the torn tendon to the bone. Recovery time will be quicker with this minimally invasive technique.
Open tendon repair. If your surgeon needs more room to work due to the extent of the injury, they will make a larger incision and operate in this open environment to reattach the damaged tendon to the bone. If the torn tendon is too damaged to be reattached, your surgeon may decide to use a nearby tendon as a replacement.
Mini-open tendon repair. This is a combination of the above 2 methods, where the operation starts with an arthroscope and ends with a larger incision so that larger instruments can be used.
Reverse shoulder replacement. If you have a massive rotator cuff injury, your surgeon may recommend shoulder replacement surgery, where an artificial joint is inserted. The ball part of the joint goes onto the shoulder blade and the socket part onto the arm bone.
How long will it take to recover?
How fast you recover and can get back to normal activities depends on:
- The size of the tear
- How long the injury was left untreated
- The type of surgery you have
The smaller the tear and the sooner it is treated with a minimally invasive procedure, the faster you will heal. But do be warned: Recovery from this type of injury is a slow process and can take as long as a year before you have full range of motion around the shoulder.
What is the recovery process like?
You will have to wear a sling for 4 to 6 weeks after surgery. You can remove the sling a few times a day to flex the elbow and improve blood supply to the arm. You should follow your physiotherapist’s exercise instructions and not force movement around your shoulder sooner than advised. Don’t try to rush the process or you could just end up delaying your recovery.
Are there risks of incomplete recovery?
As with any surgery, there are risks of complications or that the surgery won’t work. Your surgeon will discuss the following risks with you:
- detachment of the deltoid muscle at the shoulder, affecting mobility
- nerve injury in the operation site
- shoulder stiffness and pain
- infection of the wound
- future re-injury of the same tendon
While you should make a full recovery that will allow you to perform normal daily activities, it is found that only around 50% of professional athletes with a rotator cuff tear history return to the same competitive level they were at before the injury.
When should you see a doctor?
Your chances of recovery are better when you act fast in getting treatment. Consult an orthopedic surgeon to evaluate your condition and understand your treatment options as soon as you start having trouble with your shoulder.
Article reviewed by Dr. David Jiang, Orthopedic Surgeon at ParkwayHealth
Copyright: Health Plus an online health and wellness web resource developed by Parkway Singapore
References:
1. hat is a rotator cuff tear? Retrieved 8/7/20 from https://www.webmd.com/pain-management/rotator-cuff-tear#1
2. Rotator cuff injury. Retrieved 8/7/20 from https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/drc-20350231
3. Torn rotator cuff: Everything you need to know. Retrieved 8/7/20 from https://www.medicalnewstoday.com/articles/324968#recovery
