What are my treatment options after a rotator cuff tear?

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The rotator cuff tear is one of the most common reasons why patients consult their GPs about pain and disability affecting the shoulder. In fact, the first description of a rotator cuff injury can be traced back to 1600 BC, when it appeared in the Surgical Papyrus, one of the oldest known medical texts.

Injuries to the rotator cuff become more common the older you get, accounting for 5% of all GP encounters. They may occur as part of the natural ageing process of the tendon and often show no symptoms at all. It’s estimated that more than 40% of patients over 60 will have a rotator cuff tear and will not even be aware of it, instead blaming their aches and pains on just getting older.

There may not be an isolated injury or event that causes the tear; the shoulder has a relatively poor blood supply and it is also an area that sees a lot of wear over time. As the tendons start to thin, even a small amount of strain can result in a tear.

Alternatively, a rotator cuff tear can be caused by a sudden, acute injury. Often, workers engaged in heavy lifting work can suffer from these types of injuries. Injuries can also occur during simple everyday activities such as cleaning, hanging curtains or gardening.

Athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis and weightlifting can often be a cause. Tennis player Maria Sharapova had surgery to repair two rotator cuff tears in 2008. After a long recovery she finally returned to singles after a 10-month absence, but struggled for the next two years, before returning to form.

Will I need surgery to mend a rotator cuff tear?

At your consultation with the team at London Shoulder Specialists, non-surgical methods will usually be recommended first. The exact cause of the rotator cuff tear will often dictate the treatment options we advise.

Even though most tears can’t heal on their own, satisfactory function can often be achieved without surgery, so most patients with small degenerative rotator cuff tears can be treated with a combination of anti-inflammatory medication, steroid injections and physiotherapy. These options may all be of benefit in relieving pain and restoring strength to the involved shoulder. However, if the pain and lack of mobility associated with a rotator cuff tear fail to resolve, then your surgical options will be discussed with you.

Reasons where surgery might be indicated to repair a rotator cuff tear are:

  • persistent pain or weakness in your shoulder despite non-surgical treatment
  • if you are active and use your arm for overhead work or sports
  • symptoms have lasted for nine to twelve months
  • there is marked loss of function in the shoulder
  • a large tear is detected in the tendon (usually more than 3 cm)

Rotator cuff tear surgery typically entails re-attaching the tendon to the head of the upper arm bone called the humerus. A less invasive procedure, known as debridement, can be used to repair a partial tear by trimming or smoothing the tendon. A complete tear may require the two parts of the tendon to be stitched back together.

Three techniques are used for rotator cuff repair: traditional open repair, mini-open repair, and arthroscopic repair (keyhole); your consultant will advise you as to which approach is best suited to your individual circumstances.

What is the recovery like after rotator cuff tear surgery?

Rehabilitation plays a vital role in both the non-surgical and surgical treatment of a rotator cuff tear. Initially, the tendon will need to heal and you will be advised to keep your shoulder immobile for the first month or so and we recommend wearing a sling. Once the tendon has begun to heal then you will be required to undergo a programme of physical therapy aimed at returning your shoulder to its full pre-injury strength and motion.

Complete recovery can be expected approximately six months after surgery, as long as the patient rehabilitation programme has been followed. It is important to realise that there is always a chance of the rotator cuff re-tearing and the larger the initial tear, the higher the chance of that happening.