The rotator cuff muscles surround the shoulder joint, enabling humans to lift and rotate their arm. Over time, these muscles become thinner and more prone to tear due to the natural ageing process.
The terminology around rotator cuff tears can be quite confusing. Tears can be small or big. They can also be partial or full thickness. Sometimes the tear will retract, usually indicating a chronic tear. Occasionally, younger people do get rotator cuff tears but they become much more common as people age. Tears tend to increase in size over time.
Do I need to see a shoulder surgeon?
We recommend a shoulder surgeon if there is any query about the structures within your shoulder.
Most shoulder problems do not require surgery. If you have any doubt, the best approach is to see a shoulder surgeon who will examine your shoulder thoroughly and as required order investigations. X-ray and MRI/arthrogram tend to be the investigations of choice in our clinic.
If there is indication of a significant/large tear, it is desirable to see a surgeon as soon as possible, as the longer the tear is left untreated, then the harder it is for the surgeon to obtain a good operative repair.
Many older patients will have a rotator cuff tear on MRI. If the quality-of-life effect from this is minimal, then they often do not require operative treatment.
Nonoperative management usually involves,
- activity restriction – light duties – for at least three months
- home-based exercises to improve rotator cuff strength. It is important to note that improving strength does not repair a torn rotator cuff. The exercises strengthen the rotator cuff muscles that are not torn. The torn muscles remain torn.
- depending on your level of pain and how upset you are, a cortisone injection may be offered by your treating doctor
- education about lifestyle and staying comfortably active. Occasionally it is recommended to permanently modify lifestyle in order to protect the shoulder.
Depending on the size of tear and the effect that the issue is having on your quality of life, a surgical option may be offered by your treating surgeon. There are many factors involved in determining whether to operate or not. Usually after relevant tests such as x-ray and MRI, a thorough examination and particularly the effect of the issue on everyday activities, a decision is made.
If surgery is performed, the recovery takes approximately 12 months. Usually, you will spend six weeks in a sling. From week seven you are slowly weaned from the sling and a gentle range of motion exercise program is started. From the start of the fourth month, a light strengthening programme starts.
It is important to note that for the first six months you will have limited capacity with regard to lifting and general use of the affected upper limb. From month seven your lifting capacity is increased as appropriate. The surgeon will often see you at the 12- month mark for a final review.
Occasionally, there are permanent lifelong activity restrictions following significant rotator cuff injury and subsequent repair.
If you need any advice regarding your shoulder, please call Sydney shoulder clinic on 9744 2201. Ask for Tim Neville physiotherapist.