Rotator cuff injuries: when surgery is the right solution

The rotator cuff is a collection of muscles and tendons in the shoulder that anchors the upper arm bone, called the humerus, to niches in the scapula, helping the shoulder joint move in a ball-and-socket configuration. The rotator cuff helps the shoulder and arm move fluidly and without pain, but they can get injured from overuse, accidents, or wear away with time. People whose work requires them to perform a lot of overhead motions, such as carpenters and gymnasts, are prone to rotator cuff damage. In this article, leading orthopaedic surgeon Mr Daniel Neen, discusses the many ways to treat an injured rotator cuff, and how to know if surgery is necessary.

How is a rotator cuff injury diagnosed?

A patient may suspect that their rotator cuff is damaged when they feel pain when lifting their arm away from their body or over their head and when pressure is applied to the shoulder (such as lying down on their side or carrying a heavy bag), and being unable or limited when trying to move the arm or hold something heavy. The injury can be diagnosed with imaging scans like an ultrasound or an MRI.

How is a rotator cuff injury treated?

There are several options to treat an injured rotator cuff, such as a cessation of activities that caused the injury, posture, stretching and strengthening exercises, anti-inflammatory medications, or an anti-inflammatory steroid injection all have proven to be sufficient to ease pain and restore mobility.

However, there are conditions of a rotator cuff injury that may necessitate surgery to repair it, such as:

• severe, sudden injuries to the rotator cuff, causing a complete (full thickness) tear
• symptoms that have lasted for more than six months
• inability to perform everyday activities

• other treatments like medications and physical therapy have not been fruitful

Which surgery repairs a rotator cuff injury?

Surgeries to repair a rotator cuff will differ depending on what needs to be done to restore use:

• Arthroscopic tendon repair, in which the torn tendon is reattached to the bone through small incisions with help from a small camera called an arthroscope.
• Open tendon repair is similar, but there is one large incision instead. This procedure is suitable for big and complex tears. This may involve a tendon transfer, where a tendon from nearby the shoulder is used to replace the torn one as it is too damaged to be reattached.
• Shoulder replacement, where the ball of the humerus and the socket of the shoulder blade are replaced with artificial implants made of metal and plastic.

For rotator cuff injuries that have been caused over time, the tendons may be too weak for surgery, which means that some older patients with many years of wear and tear will not be suitable for tendon repair surgery.

What happens after rotator cuff surgery?

The surgery may relieve some pain and weakness, and enable easier movement of the shoulder, but may not restore full strength to the shoulder, which is why patients are encouraged to also partake in physical therapy for a few months post-surgery. After surgery, patients should not use the affected arm for up to six weeks while it heals. Furthermore, patients should avoid lifting heavy objects, doing excessive overhead gestures and movements, and sports or activities that involve throwing and overhead movements to prevent repeated injuries to the rotator cuff.

If you are struggling with shoulder pain or believe you may have damaged your rotator cuff, you can book an appointment with Mr Neen on his Top Doctors profile.