Rotator Cuff Tear Adelaide - Treatment and Surgery
Dr Arthur Turow Shoulder SurgeonA rotator cuff tear can make it painful to sleep on your shoulder, lift your arm or manage everyday tasks. Some tears follow an injury, while others develop gradually as the tendon changes with age.
Dr Arthur Turow is an Adelaide orthopaedic surgeon specialising in shoulder and upper limb conditions. He assesses rotator cuff tears and discusses treatment options, including physiotherapy, pain management and arthroscopic rotator cuff repair when surgery is appropriate. Consultations are available at Wakefield Orthopaedic Clinic in Adelaide and at regional clinics across South Australia.
The supraspinatus tendon is the rotator cuff tendon most commonly affected by a tear. It helps lift the arm and stabilise the shoulder.
The rotator cuff is a group of 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: The tear extends through part of the tendon’s thickness.
2. Full thickness tear: The tear extends through the full thickness of the tendon. It may affect part or all of the tendon’s width.
What are the most common causes for rotator cuff tears?
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. Longstanding, large rotator cuff tears can lead to a condition called rotator cuff tear arthropathy, a form of shoulder arthritis. For patients with advanced rotator cuff disease and associated shoulder arthritis, reverse shoulder replacement may be an option when other treatments are not working.
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.
What are the common symptoms?
A rotator cuff tear often causes shoulder pain and weakness. Pain and weakness usually are most noticeable with activity, for example when raising your arm above your head when getting dressed or reaching into cupboards. Pain can sometimes persist at night, especially when lying on the affected side. Sometimes you may also feel a catching or clicking sensation in the shoulder with movement. Together, these symptoms can make everyday activities difficult and limit quality of life.
Shoulder bursitis or shoulder arthritis can occur alongside a rotator cuff tear and contribute to shoulder pain. An assessment of your shoulder is important to guide treatment.
How is a rotator cuff tear diagnosed?
Dr Turow will ask how your symptoms started, examine your shoulder and assess its movement and strength. An ultrasound or MRI may help identify the tear and guide treatment. Imaging findings are considered alongside your symptoms and what you need your shoulder to do.
Arrange an assessment if pain or weakness persists or affects sleep, work or daily activities. Seek prompt medical assessment following a shoulder injury if you develop significant weakness or cannot lift your arm, particularly if this is new.
Treatment Options for a torn rotator cuff
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-surgical Treatment:
- 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.
- Physiotherapy: Specific exercises and stretching of your shoulder may be helpful. Your physiotherapist can guide you through strengthening exercises of your rotator cuff, improve your shoulder mechanics, and work on stiffness to restore your range of motion.
- Pain relief: 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.
- Corticosteroid injection: An injection may sometimes help relieve pain, although it does not repair the torn tendon.
- Other alternative modalities: Heat or cold therapy, shockwave therapy, laser therapy, or electrical stimulation can alleviate pain and potentially promote healing; but these treatments have limited or inconsistent evidence for treating rotator cuff tears and should not be considered substitutes for dedicated shoulder care.
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.
Shoulder Arthroscopy
Recovery after rotator cuff repair
Stage 1: Protecting your Repair (0 to 6 Weeks)
- 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 (6 to 12 Weeks)
- The sling is gradually weaned
- Shoulder movement and stretching are gradually increased with your physiotherapist
- Exercises focus on movement while protecting your tendon repair
- Heavy lifting and resisted rotator cuff strengthening remain restricted until about 12 weeks
Stage 3: Strengthening (3-6 Months)
- The next three months you focus on strengthening
- Resistance training is increased
- You can return to swimming
Stage 4: Return to full activities (6+ Months)
- From six months onwards you can return to full activities
- You can return to sports and manual work
Why Choose Dr Arthur Turow for Rotator Cuff Surgery in Adelaide
Dr Turow is an Australian-trained orthopaedic surgeon whose practice focuses on shoulder and upper limb conditions. His qualifications include FRACS (Orth) and FAOrthA. He holds staff specialist appointments at the Royal Adelaide Hospital and The Queen Elizabeth Hospital. He also holds a Master of Surgery and is a clinical lecturer with the University of Adelaide.
Treatment begins with an assessment of your symptoms, examination and imaging. Dr Turow will discuss with you non-surgical and surgical options; including whether a repair is needed and how treatment would affect your work, sports and everyday activities.
Consultations are available in Adelaide CBD and at regional locations across South Australia, including Yorke Peninsula, Gawler and Mt Barker.
Read more about Dr Turow and his training.
Frequently Asked Questions
Can a rotator cuff tear heal without surgery?
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 lose function. If you are concerned about your shoulder or any imaging findings, it is best to have your shoulder assessed by a specialist.
How long does recovery take without surgery?
Improvement usually happens over weeks to months. The aim of your treatment is to reduce pain and improve movement and strength, rather than assume the tear has healed. You should see the most improvement over the first six weeks with further gains for up to 4-6 months. If you have ongoing weakness, worsening symptoms or difficulty using the arm beyond that, then you should seek help to review your treatment.
Do all rotator cuff tears need surgery?
No. Many small or partial tears can be managed without surgery. Surgery may be considered if your shoulder continues to have pain and weakness, the tear is large, or your shoulder does not function properly and you cannot return to your activities.
How long does recovery take after rotator cuff repair?
Rehabilitation takes several months. Most patients need to wear a sling for 4-6 weeks and begin physiotherapy soon after surgery. Full recovery and strength often take up to six months; this can vary depending on the size of your tear and your activity level.
For Patients
If shoulder pain or weakness is affecting your daily life, book a consultation with Dr Arthur Turow to discuss your symptoms and treatment options.
Adelaide consultations are available at Wakefield Orthopaedic Clinic, Level 2, 120 Angas Street, Adelaide SA 5000. Regional consultations are also available. Call (08) 8236 4179 or book online.
Bring your referral and any existing shoulder scan reports or images. See the first-visit information for details.