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Rotator Cuff Tear
The rotator cuff is formed by four muscles and their tendons around the shoulder. These tendons join together to form a cuff around the ball of the shoulder joint and help with lifting and rotating the arm, as well as keeping the shoulder stable.
A rotator cuff tear can happen after an acute injury, such as a fall or sudden pull, but it can also develop gradually over time as part of wear and tear within the tendon.
Patients usually complain of pain and weakness in the shoulder, particularly when carrying out activities above shoulder level, such as combing the hair or reaching up to a high shelf. Pain at night is also common, especially when lying on the affected shoulder.
Diagnosis
Diagnosis is based on the symptoms, clinical examination, and shoulder imaging. It is usually advisable to have an X-ray of the shoulder, as this can show bony changes and help exclude other causes of pain. An ultrasound scan is useful to assess the rotator cuff tendons and can confirm the presence of a tear. The most important and relevant investigation is often an MRI scan, as it provides more detailed information about the size of the tear and the condition of the tendon and muscles, which helps in planning the most appropriate treatment.
Treatment
Treatment may be non-operative or operative, depending on the size of the tear, the severity of symptoms, and the level of weakness and loss of function.
Non-operative treatment usually includes pain relief, anti-inflammatory medication if appropriate, physiotherapy, and sometimes a steroid injection to the shoulder to help reduce pain and inflammation.
Surgical treatment may be recommended when pain and weakness continue despite appropriate conservative treatment, or when the tear is caused by an acute injury and there is significant weakness or loss of function. Many rotator cuff tears can be repaired using arthroscopic (keyhole) surgery. In some cases, a mini-open repair may be used, which means a smaller incision is made to repair the tendon in a less invasive way. Larger or more complex tears may require an open repair, which involves a larger wound to allow direct access to the tendon.
If the tear is large or the tendon tissue is of poor quality, the repair may sometimes need to be strengthened using a graft. This may come from another structure within the shoulder or from donor tissue, depending on what is most suitable for the individual case.
The operation is usually performed as a day-surgery procedure.
Further detailed information and most appropriate treatment option would be provided during the consultation with Mr. Khalid Ayoub. Back...
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