Rotator Cuff Tear Treatment
- The rotator cuff is a group muscles in your shoulder helping with stability and movement
- Rotator cuff tears can lead to shoulder pain, weakness and stiffness
- Most rotator cuff tears can be treated without surgery
- If your shoulder is not improving & you have persistent shoulder pain & weakness, you may need surgery
- Surgery for rotator cuff tears is done arthroscopically (key-hole)
- Recovery after rotator cuff surgery can take 4-6 months
What is the rotator cuff?
The rotator cuff consists of four muscles and their tendons that encircle the shoulder joint. The rotator cuff provides stability to your shoulder and helps your shoulder move. Rotator cuff tears happen when these tendons suffer damage either from an injury or, from wear and tear.
There are two types of rotator cuff tears:
1. Partial thickness tear: This type of tear affects a portion of the tendon usually starting small and potentially worsening if left untreated.
2. Full thickness tear: This tear involves a complete rupture of the entire tendon from its bony attachment. It can occur suddenly due to an injury or gradually over time due to changes in the tendon.
Several factors can contribute to a rotator cuff tear. The top three common causes include:
Acute injury: A sudden traumatic event like a fall, heavy lifting or direct impact to the shoulder can injure the rotator cuff. An acute injury typically leads to loss of motion and weakness.
Degenerative changes: As we age, natural wear and tear of the rotator cuff tendons occurs. In addition, capacity of the rotator cuff to repair itself is reduced. These processes lead to degeneration and weakening of the tendons, making them more susceptible to injury and tearing. In cases of degenerative tears, loss of motion and strength tends to occur gradually rather than suddenly.
Repetitive movement: Engaging in repetitive actions such as continuous work exposure, throwing, lifting heavy objects or taking part in specific sports can gradually result in tears within the rotator cuff due to strain on the shoulder joint.
How do you know if you have damaged your rotator cuff?
The symptoms of a rotator cuff tear can vary depending on the location of the tear, how many tendons have been torn or how large the tears are. Common symptoms you may experience include:
- Pain: Pain is typically felt deep within the shoulder or at your shoulder tip. Sometimes you may also feel pain at the back of your shoulder. You pain may worsen with arm abduction (moving the arm away from your body) or when reaching out or with lifting activities.
- Weakness: You may notice that your shoulder is weaker than your normal shoulder. This can be subtle and shoulder ideally be assessed by a shoulder specialist.
- Limited range of motion: Reduced ability to move the shoulder fully, particularly in abduction (moving the arm away from your body) can be a sign of a rotator cuff tear. Other motions that may be limited are external rotation (rotating your arm outward) or internal rotation (rotating your behind your body and reaching between your shoulder blades).
- Shoulder stiffness: You may notice that your shoulder is stuck and cannot move as well as your normal shoulder
Can a rotator cuff tear heal on its own?
While some healing is possible, most rotator cuff tears tend to get larger over time. The biology of rotator cuff tears is complex and healing depends on why your rotator cuff has torn. Although rotator cuff tears may progress over time, this may not necessarily mean that your shoulder will get weaker or loose function. If you are concerned about your shoulder or any imaging findings, it is best to have your shoulder assessed by a specialist.
Rotator Cuff Tear Treatment
The treatment for a rotator cuff tear depends on various factors, such as the size, location, and severity of the tear. In addition, your symptoms, your functional goals, and overall health can guide treatment. If you have a full thickness cuff tear that has occurred because of an injury or are experiencing loss of function not responding to non-operative measures you may benefit from surgery. The broad treatment options are:
Non-operative Treatment:
- Rest and activity modification: Avoid activities that aggravate your shoulder. Allow your shoulder to rest and heal. A sling may be beneficial to help you for the first few weeks.
- Physical therapy: Specific exercises and stretching of your shoulder may be helpful. Your physiotherapist can guide you through strengthen exercises of your rotator cuff, improve your shoulder mechanics, and work on stiffness to restore your range of motion.
- Pain management: It is best to stick to simple pain relief, such as Paracetamol (Panadol) or nonsteroidal anti-inflammatories (NSAIDs; Nurofen). Long-term use of strong pain killers should ideally be avoided., but can be used for a brief period to help you recover. Other options are injections of your shoulder with corticosteroids to reduce pain and inflammation.
- Other alternative modalities: Heat or cold therapy, shockwave therapy, laser therapy, or electrical stimulation can alleviate pain and promote healing. Everyone responds differently to these treatment options and you may need to trial different options to find out what works best for you.
Surgical Treatment:
- Arthroscopy: This is a minimally invasive procedure in which small incisions are made, and a specialised camera and surgical instruments are used to view and to repair your torn rotator cuff tendon.
- The rotator cuff is repaired back to bone using strong anchors that are inserted into your bone. The anchors have several sutures inside them which are used to tie down the rotator cuff tendons and to compress them against your bone. This allows the rotator cuff to heal and to restore your strength and range of motion.
What to expect after rotator cuff surgery?
The rotator cuff is repaired back to bone using specialised anchors. While these anchors are strong, the repair relies on your body to heal and this takes time. This usually takes at least three months. During this time, you need to protect the repair by restricting your activities to some degree. After your tendons have healed, your shoulder needs to regain its strength back, which frequently takes another 6-9 months. Your physiotherapist will guide you through the stages of rehabilitation. An approximate timeline is outlined below:
Stage 1 – Protect Repair
- In the first six weeks the repair needs to be protected
- You can start on some early range of motion from two weeks
- You will need to wear a sling during this time
Stage 2 – Increase Range of Motion
- This stage covers weeks 6-12
- The sling is gradually weaned
- You start on active range of motion
- Low-resistance strengthening is introduced
Stage 3 – Strengthening
- The next three months you focus on strengthening
- Resistance training is increased
- You can return to swimming
Stage 4 – Return to full activities
- From six months onwards you can return to full activities
- You can return to sports and manual work
Get Expert Help
Symptoms with a rotator cuff tear can vary from patient to patient. If you are experiencing shoulder pain, limited mobility, or other concerning symptoms, it is best to be seen by a shoulder surgeon. Dr Arthur Turow is an Australian trained shoulder surgeon based in Adelaide. He can assess your shoulder, provide you with an accurate diagnosis and suggest tailored treatment options specific for your individual needs.
Please use above information as a guide only. More detailed information specific to your condition and your recovery will be given in your consultation with Dr. Arthur Turow, who will also provide additional resources to supplement your discussion. For more information, please contact the rooms of Dr. Arthur Turow on (08) 8236 4179.