Rotator Cuff Injury Treatment Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
A rotator cuff tear is a rupture of the sleeve of tendons (rotator cuff) surrounding the ball your shoulder joint (which comprises a ball and socket joint). The rotator cuff tendons connect muscles of the shoulder blade to the upper arm bone (humerus). These muscles, in turn, provide stability and mobility to your shoulders.
What is a Rotator Cuff Tear?
Rotator cuff tears are extremely common. It is estimated that 21% of the population have rotator cuff tears, although the incidence is much higher in the older population.
Another interesting fact is that many people with rotator cuff tears may not be symptomatic at all! In fact, the incidence of asymptomatic rotator cuff tears appears to be higher in older patients.
It is estimated that up to 2/3 of patients in their 60s with rotator cuff tears may not be symptomatic. The remaining 1/3 of patients seek help because of pain in their shoulders, especially during movements of their arms at their shoulders.
What Causes Rotator Cuff Tear?
Sometimes, patients may develop rotator cuff tears without remembering any inciting event or injury. Rotator cuff tears can occur in many instances, and an injury to the shoulders is one of the most common occurrences.
Here are some other causes of rotator cuff tears:
- Overuse, especially overhead activities
- Wear and tear over time
- Acute injury
Symptoms of Rotator Cuff Tear
- Shoulder pain and tenderness
- Dull ache
- Arm weakness
- Difficulty reaching behind the back or out to the side
- Decreased range of motion
How Is Rotator Cuff Tear Diagnosed?
X-Ray
Ultrasounds
MRI Scan
How To Treat Rotator Cuff Tear?
Rotator cuff tears can range in severity greatly. Treatment depends very much on how bad the tear is. We usually classify tears into the following: partial tears, small full thickness tears, medium tears, large tears, massive tears and finally, cuff tear arthropathy (where the joint is permanently damaged due to the presence of severe rotator cuff tears).
Common treatment methods include:
- Rest
- Warm compression to minimise pain.
- Anti-inflammatory medications such as ibuprofen, etoricoxib and naproxen
- Strengthening exercises and physical therapy
- Cortisone injection to reduce inflammation (controversial)
Anatomy of the Shoulder Joint
The shoulder joint is made up of 3 bones: the shoulder blade (scapula), the humeral head and the collar-bone (clavicle).
Movements around the shoulder involve 3 separate articulations: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic articulation. When the arm is raised, the majority of movement occur at the glenohumeral joint and the scapulothoracic articulation.
Four (4) muscles are attached to the scapula and send their respective tendons across the glenohumeral joint and attach to the humerus just beyond the humeral head. These 4 tendons are collectively known as the rotator cuff.
You can think of the muscles as motors and their tendons as pulleys. Contractions of the muscles will hence bring about movement at the joint that their tendons cross.
Frequently Asked Questions
What will the doctor do?
Your doctor will chat with you and ask you more about the. A careful examination of the shoulder is then carried out. He (I will use “he” to refer to the doctor to simplify the discussion although clearly, there are many female doctors out there!) will need to visually inspect your shoulders, looking out for any asymmetry or wasting of the muscles.
He then feels around the shoulder looking for any tender spots which may give a clue as to the source of the problem. This may be particularly hard in large or muscular patients.
He then tests your shoulder movements. Rotator cuff tears often do not cause any restriction of range of movement unless the tear has been there for a certain amount of time, and the patient’s reluctance to move the shoulder fully due to pain has resulted in a stiffness of the joint (secondary frozen shoulder).
Your doctor will then test the strength in each of the rotator cuff muscles. The most commonly torn tendon is the supraspinatus tendon and many patients with rotator cuff tears will have decreased power in the supraspinatus.
However the patient may also have tears of the other rotator cuff muscles and weakness will then correspond to the whichever tendon is torn.
Is a rotator cuff tear serious? When should I visit a doctor?
A rotator cuff tear generally does not heal on its own without proper treatment. If left untreated, a rotator cuff tear can worsen, resulting in significant loss of mobility and arm function.
You should visit a doctor if you experience extreme pain that does not improve with home remedies such as rest, warm compression or over-the-counter inflammatory medications, or if your symptoms interfere with your daily functioning.
How to prevent a rotator cuff tear?
- Warm up and stretch your body before exercising or engaging in strenuous activities
- Avoid overuse of shoulders
- Exercise to strengthen the shoulder
How is rotator cuff surgery performed?
The tendon tear almost always occurs at the area where the tendon joins the bone. An analogy would be the “glue” holding the tendon to the bone has weakened and the tendon comes off the bone.
The aim of the surgery is thus to reattach the tendon to the bone. This is done via keyhole surgery or minimally invasive surgery. For a more detailed description of shoulder surgery, please refer to the page on Keyhole Surgery.
There are many ways to repair the tendon tear. A detailed discourse of tendon repairs is beyond the scope of this article. Basically, as tendons are somewhat rubbery in texture, it is easy to pass stitches through the tendon to pull the torn and sometimes retracted tendon back to place.
To hold it fast to the bone so that it can eventually heal up and reattach itself to the bone, it is necessary to use suture anchors. Suture anchors are small implants made of either metal (often titanium) or medical grade plastics.
They measure about 0.5 cm in diameter and 1 cm in length. A hole just big enough to insert the suture anchor is made in the bone the suture anchor is screwed in. The sutures are then passed through the tendon and tightly tied in place, firmly securing the torn tendon to the bone.
These anchors are designed to be permanent and will not cause any problems like rejection or corrosion. They do not need to be removed.
What kind of anaesthesia will I require?
I often do these surgeries under general anaesthesia. An anaesthetist will be present throughout the surgery to not only anaesthetize the patient, but also to monitor the patient throughout the duration of the surgery to ensure safety of the patient. Please read the section on anaesthesia for more information.
How long does the surgery take?
The surgery usually takes slightly over an hour. But complicated cases can take up to 2 hours.
Can I return home on the same day as the surgery?
Yes, certainly you can return home on the same day. Many patients, however, find it more convenient to stay overnight. This is because you may be feeling rather drowsy and tired after you wake up from the anaesthesia.
How long will I take to recover?
Full recovery can take anything from 6 months to a year. Physiotherapy is very important after the surgery because patients will always develop temporary stiffness of the shoulder after the surgery. But with physiotherapy, most patients can expect to recover full functionality of the shoulder. For more details about physiotherapy, please refer to the section on Physiotherapy.
What should I do now?
If you have managed to get to this part of this long article, your shoulder must be bothering you significantly! Consult your family doctor or see an orthopaedic specialist and he/she should be able to advise you accordingly.
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38 Irrawaddy Road, #10-41
Mount Elizabeth Novena Specialist Centre
Singapore 329563 - shouldersurgeonsg@gmail.com
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Singapore 217562 - shouldersurgeonsg@gmail.com
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