Rotator cuff tear (acute)

What is and acute tear of the Rotator cuff?

The rotator cuff is a group of four muscles which attach to the top of the humerus bone. All four muscles are involved in moving the arm in space. They are also important for the stability of the shoulder. An acute rotator cuff tear is a tear of one or more of the tendons attached to the top of the humerus bone. This can be from a traumatic injury where the shoulder was dislocated or jarred. It can even occur after you fall onto an outstretched hand or onto your elbow as the forces can still tear tendons at the top of the arm.

What are the common symptoms and signs?

The main symptoms of a rotator cuff tear are pain around the shoulder joint. There commonly can also be weakness associated with a rotator cuff tear. Sometimes patients are unable to lift their arm above their head or even to shoulder height which can be evidence of a large rotator cuff tear involving two or three tendons.

What imaging and investigation is required?

The basis for diagnosing an acute rotator cuff tear is to obtain plain X-Rays. This will show whether or not there are any associated fractures of the bone associated with the tear which can occur. Next important investigation involves imaging of the soft tissues and the tendons themselves which do not show on X-Ray. As such we usually use Ultrasound or MRI preferably to have a close look at the tendons themselves. With the scans we are specifically looking for the size of the tear and the number of the tendons involved. We also will look at the quality of the muscle bellies attached to those tendons to get an idea of how recently the tear has occurred.

What are the treatment options and what are the surgical treatments available?

Broadly speaking there are operative and non-operative options. Non-operative options include rest, physiotherapy, anti-inflammatories and ultrasound guided injections. Large tears or tears that are associated with the significant amount of weakness should generally be repaired as soon as possible. Rotator cuff repairs are performed via arthroscopic means which is keyhole surgery of the shoulder. It normally requires three or four 1cm incisions around the shoulder joint through which the torn tendons can be repaired. The torn tendons are normally repaired with anchors that re-attach the tendon to the bone.

What is the expected outcome from the surgery?

Rotator cuff surgery for acute rotator cuff tears offer very good results as there is normally minimal retraction of the tendon and fresh healing services that confer higher rate of healing. In general, better results are associated with fresh tears in younger patients that aren’t large. The larger the tear, the older the patient and the longer it’s been since it’s sustained the tear all reduce the chance of the tendon healing to the bone.

What are the specific risks involved in rotator cuff surgery?

The specific risks in rotator cuff surgery include re-tear or incomplete healing of the rotator cuff, frozen shoulder, incomplete pain relief and very rarely infection or bleeding.

What is the post-operative rehabilitation process?

The process for rehabilitation after rotator cuff tear repair requires you to be placed in a sling for 6 weeks. You can come out of the sling for showers and meals and for when you are sitting at a desk or when you are using a computer.