Rotator Cuff Tear

A rotator cuff tear is a common tendon injury in middle-aged people, most commonly over the age of 60, that involves the four internal muscles that envelop the shoulder joint.

There are two general types of rotator cuff tear:

• Acute tears occurring in seasoned athletes or ‘weekend warriors’ with sports injuries,
• Chronic tears due to long term wear and tear, although some patients may experience a mixture of both acute and chronic injuries.

“Rotator cuff tears usually go hand in hand with other shoulder conditions that can include arthritis, bone spurs, frozen shoulder, shoulder impingement, and biceps tendon tears, and further evaluation should be made by an experienced shoulder surgeon or sports medicine physician,” says Dr Philip Markham, Gosford shoulder surgeon

It’s possible to have a torn rotator cuff without experiencing any symptoms, says Dr Markham.
“In fact, 50% of tears don’t cause symptoms, according to a 2022 study published in BMJ Open.*

However when there are symptoms they typically include

• Pain in the shoulder and side of the arm
• Difficulty lifting the hand
• Weakness in the shoulder, especially when completing overhead movements or stretching
• Many people also experience shoulder pain while sleeping, especially when lying on their side.
• In addition, reaching behind your back to get something may become unusually difficult.

If these symptoms persist for several weeks, especially if they are accompanied by limited shoulder movement, you should seek medical attention as soon as possible to check for a rotator cuff tear.

What is a rotator cuff tear?

• Falling down
• Lifting heavy objects
• Repetitive movements (e.g., painting or weight training)
• Competitive sports

Additionally, chronic tears can be caused by gradual wear and tear and thinning of the tendon with age.

“And a rotator cuff tear can further lead to the development of frozen shoulder or periarthritis (adhesive capsulitis), which is characterized by pain and stiffness, and a loss of rotational mobility in the shoulder,” says Dr Markham.

Early intervention can prevent a partial tear from worsening into a full tear requiring surgery.

Whether it’s non-surgical treatment or surgical repair, taking action as early as possible is key to restoring your health.

Shoulder health is important, so don’t ignore what may seem like “ordinary” signs of pain!

• Partial tear: usually recovered through non-surgical treatments including physical therapy, anti-inflammatory medications, or steroid injections, which reduce inflammation and help the shoulder regain strength.
• Full tear: requires surgical repair to reattach the torn tendon to the bone. Surgery is usually performed using minimally invasive arthroscopic techniques that are less invasive and quicker to recover from. After surgery, the shoulder will be protected by wearing a sling for 6 weeks while undergoing a gradual program of physical therapy.

Although rotator cuff surgery is a common and safe treatment, the following risks may still be present:

• Common side effects: Pain, swelling and bruising may occur for a few days after surgery, which can be relieved with ice and pain medication. Shoulder stiffness is more common in the early post-operative period, but physical therapy can help with return to activity.
• Potential Complications: If infection (manifested by fever, redness, swelling or pus in the wound) occurs, immediate medical attention is required. Rarely, nerve damage may cause temporary or permanent weakness or abnormal sensation.
• Risk of re-tear: Failure to follow the doctor’s recommendations during the recovery period (e.g., premature use of the affected shoulder) may result in re-tear.
• Risk of anesthesia: As with all surgeries, anesthesia may cause a mild or severe reaction, but this is rare.
• Recovery from surgery requires patience and cooperation. Wearing a sling and physical therapy as prescribed will minimize the risks and promote complete healing of the shoulder.