What are the symptoms of a rotator cuff tear?

Typically, you will feel pain on your shoulder and arm. You may note weakness of your arm and difficulty with overhead activities such as combing your hair. You may feel pain when you try to sleep on the affected side.

How is a rotator cuff injury diagnosed?

There are specific tests for the trauma specialist to diagnose this kind of injuries. Palpation of the tendon will normally cause discomfort.  The specialist can also perform strength testing on the rotator cuff motion to check the different strength between the two arms. The specialist may order an ultrasound or a Magnetic Resonance Imaging (MRI) scan to confirm the diagnosis.  When diagnosing a rotator cuff injury, it is always important to quantify the size of the injury and the level of degeneration of the tendon, in order to check whether it can be repaired or not.  “Massive rotator cuff tears” are the greatest tears and involve several tendons. These will be retracted, have a lot of fatty tissue and show atrophy. This kind of injury may be beyond the point of repair. 

SURGICAL TECHNIQUE:

What are the treatments for a rotator cuff injury?

Inflammation of the tendon can be treated with physical therapy and even injections on your shoulder. When a rotator cuff tear is confirmed, it will be worth performing a rotator cuff repair. Many of these injuries may increase in size over time and stress will eventually lead to wear and tear on your shoulder. Elderly patients (70-80 years old) with a degenerate tendon and wear of the joint are not the best candidates for surgery. These patients frequently suffer injuries in their biceps from contact friction, too. There are many other treatment options for this kind of injuries, such as infiltrations, physical therapy and an arthroscopy to clean out the shoulder and to relieve tension on the biceps.  For patients where their rotator cuff is pinching, enough room can be created for the tendons not to pinch (acromioplasty).

An approach for the rotator cuff tear can be an open procedure, but most injuries are best treated with arthroscopic surgery, which offers many benefits, as it allows for shorter recovery time and less postoperative pain, with minimal scarring. In this procedure, threaded “screws” are used to fix the cuff in place (anchors).

RECOVERY TIME:

what type of rehabilitation will be needed?

If the tendon has been repaired, you will need to use a shoulder immobilizer (sling) for 4 - 6 weeks.  If the tendon was adequately fixed, typically you should start with light exercises under supervision right away, so to avoid the likelihood of developing stiffness.

What will happen if the rotator cuff is not repaired?

Chronic rotator cuff injuries can lead to "arthropathy", which means premature shoulder wear with pain and movement limitation. The best solution for this condition would be a shoulder prosthesis.

What is a dislocated shoulder?

A dislocated shoulder involves two bones: it occurs when the head of the humerus (a ball) separates from the glenoid (a socket where the ball fits).  These bones are attached to each other by soft tissue, which makes the shoulder joint have the greatest range of motion of the body, at the cost of low joint stability.  The glenoid labrum (soft tissue) provides attachments for the shoulder capsule to maintain joint stability. Activities that stress the shoulder excessively can cause those two bones to separate, thus dislocating the shoulder and stretching and tearing the tissue in varying degrees, leading to instability.

How does it happen?

The most frequent form of dislocation occurs when the head of the humerus is displaced forward (anterior dislocation of the shoulder). This can be caused by a fall or a twist of your arm. Dislocations often occur in contact sports. Repeated episodes of dislocation may occur when tissues become loose and, specially, if you have had a shoulder dislocation in the past. The risk of repeated dislocation is higher in young people and those involved in any type of active sport. 

What are the symptoms?

Severe shoulder pain on your shoulder and arm right after the dislocation, which increases with motion. You will typically feel a need to hold your arm at the side of body in external rotation when it comes to anterior dislocations, and to hold the arm adducted and internally rotated when a posterior dislocation occurs.  Also, the side silhouette of your shoulder may have an squared-off appearance instead of its typical rounded contour.

How is it diagnosed?

The doctor will check for pain, numbness and limited motion at the shoulder joint.  If your shoulder joint is back in its normal position, some movements will feel unstable. An X-ray is requested to confirm the diagnosis, and even CT and MRI scans can be done to check for other injuries.

What are the treatments available?

Apply ice on your shoulder immediately. After dislocation, it is necessary to return the bones to their normal position (reduction) using special techniques. After reduction, your shoulder will need to be immobilised (sling) for 3 weeks, and then it is worth completing a physical therapy programme.  Never let untrained individuals pull or manipulate your arm. This will only cause further damage -as you may have a fracture.

After a shoulder dislocation, it is essential to determine the risk of repeated dislocation based on your examination, your age and your daily activity. Remember: Every time your shoulder slips out of place, injuries are more likely to occur and more complicated injuries may arise on the bones, leading to chronic instability and premature wear of the shoulder joint.  If you are at high risk, do not wait, stabilization is worthwhile. It is being said that high-risk patients -male, young people who play contact sports- should be stabilised from the first subluxation. However, this technique should not be performed immediately, but instead, after the shoulder has been cooled down, pain has been subsided and motion has been recovered.  

SURGICAL TECHNIQUE:

Arthroscopic surgery is performed through tiny incisions of 0.5cm around the shoulder joint. Then the joint capsule is sewed to the detached glenoid labrum with anchors -threaded screws, or with extremely strong suture anchors (Bankart repair).

This surgery is not a procedure with a 100% success rate, regardless of the surgeon performing it. The success rate is actually 90-95%. An open surgery may also be recommended, especially in chronic shoulder dislocation.

RECOVERY TIME:

Recovery time is different from one patient to another. In shoulder dislocation as well as in shoulder surgery, the recovery time always takes around 12 weeks. During that period, the patient will need to rest the arm while following physical therapy with range-of-motion exercises from the beginning. You might have to wear a shoulder immobilizer for 4 - 6 weeks after the surgery. You can usually resume your physical and sport activities once your shoulder has regained full strength and the range of motion is similar to the healthy shoulder.