What is a rotator cuff injury?
The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder.
A rotator cuff injury can result in a painful shoulder which may even disturb sleep.
Who may get a rotator cuff injury?
Rotator cuff injuries may occur to both the young and older patients.
They may be associated with a single traumatic incident or multiple frequent overhead motion.
In many cases, degeneration without significant injury can also lead to a rotator cuff tear.
What are the symptoms of a rotator cuff injury?
Patients with rotator cuff injuries usually report one or more of the following symptoms:
- Painful motion of the shoulder, especially overhead movements
- A painful shoulder that may distribute towards the elbow and neck
- A stiff shoulder
- A “weak” shoulder
- Inability to lift the arm
- Painful sleeping on the shoulder
When to see a doctor for shoulder pain?
Shoulder pain that is of short duration can be evaluated by your family doctor.
If the pain is prolonged or weakness is experienced, you should see an orthopaedic specialist in Singapore who has a special interest in shoulder conditions at the earliest possible time.
What is done to diagnose a shoulder rotator cuff injury?
The diagnosis is made initially with a thorough history taking and physical examination.
Xrays are done to evaluate the shoulder for other possible shoulder conditions which can also present with pain.
The diagnosis of rotator cuff injury is subsequently confirmed with an ultrasound scan or a Magnetic Resonance Imaging (MRI) scan. Your orthopaedic doctor will help recommend the type of scan needed.
How can rotator cuff injuries be treated?
Many people recover from rotator cuff disease with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.
However, extensive rotator cuff tears may require surgical rotator cuff repair, transfer of alternative tendons or joint replacement. In certain cases, a specialized procedure known as superior capsule reconstruction may benefit patients.
What are the possible complications if I do not seek treatment for a rotator cuff injury?
Without treatment, rotator cuff problems may lead to permanent loss of motion and function of the affected arm.
This may lead to progressive degeneration of the shoulder joint which can be a source of long term pain and discomfort.
Although it is possible to relieve a painful shoulder by resting the shoulder, immobilization of the shoulder for a prolonged time may cause the connective tissue surrounding the shoulder joint to become thickened, painful and tight. This is also known as a “Frozen Shoulder”
What if physical therapy and injections fail?
In patients that have severe rotator cuff injuries, physiotherapy or injections may not be helpful.
In such patients, the rotator cuff specialist may suggest the option of surgery.
What is Arthroscopic “Key-hole” Surgery?
Most rotator cuff tear repairs involve “key-hole”, minimally invasive surgery.
This will allow the orthopaedic surgeon to access the shoulder joint easily and repair the rotator cuff tear with special implants that reattach the rotator cuff tendon. During this procedure, any excessive bone prominence will also be removed to aid in tendon healing.
A patient who undergoes this surgery often returns home the next day after surgery.
What is Superior Capsular Reconstruction?
Superior capsular reconstruction (SCR) is a surgical procedure that has a niche role in patients with severe rotator cuff tears. It is usually indicated in patients who are deemed too young for shoulder replacement surgery.
This procedure involves the reconstruction of an important stabilizing soft tissue structure in the shoulder joint. It requires the transfer of a substitute soft tissue graft from either the patient (autograft) or another person (allograft).
A patient who undergoes this procedure will likely be able to return home the next day after surgery.
What is a Shoulder Replacement Surgery?
There will be some patients who have excessively severe rotator cuff tears that cannot be repaired effectively.
In such cases, the shoulder joint may need to undergo open shoulder replacement to allow for better function and pain relief to the patient.
This will involve a removal of the diseased shoulder joint and replacing with a metal prosthesis.
A patient undergoing this procedure will likely be able to return home in 3-5 days after the surgery.
What is the rehabilitation like after shoulder surgery?
The duration of rehabilitation with physical therapy will depend on the type of surgery done.
Patients will be expected to wear an armsling for a few weeks after surgery. This will be determined by the surgeon.
In general, rehabilitation after arthroscopic “key-hole” surgery will last for 6 to 12 months.
Rehabilitation after open shoulder replacement surgery will last for usually 12 months.
It is important to stay compliant to the rehabilitation program and also be compliant to pain relief medications during this time to have the best outcome after surgery.