Rotator Cuff Tears
This often occurs due to repeated tendon pinching (impingement) on the outer edge of shoulder blade (acromion).
It may result from a fall, dislocation, or trying to lift a heavy object.
They are more common among middle aged and elderly people.
Patient problems: pain and weakness of the shoulder, particularly with overhead movements eg brushing hair, dressing, hanging up clothes etc.
Investigations: x-ray, ultrasound, MRI scan
Non-surgical treatment: Physiotherapy +/- injection for partial thickness tears
Full thickness tears generally do not heal on their own. Treatment options include:
- Rotator cuff repair
- Latissimus dorsi tendon transfer
- Reverse shoulder replacement
Rotator Cuff Repair
The torn tendon ends are fixed down to the bone using suture anchors. This is usually done by a combination of keyhole (arthroscopic) and mini open surgery.
Benefits: increased function and strength within the shoulder. Decreased pain.
Risks: pain, swelling, bleeding, infection, stiffness, retear.
Anesthesia: General anaesthetic and a nerve block to help with pain relief. The numbness from the nerve block will wear off within 24 hours.
Duration in hospital: 0.5 days or overnight
After Surgery
Your arm will be in a sling for 6 weeks after surgery. Neck movements, shoulder blade shrugs, elbow and hand movements are encouraged. Try to avoid moving your shoulder (glenohumeral) joint during this period.
Wound check at 2 weeks with Dr McGonagle’s practice nurse.
Review with Dr McGonagle at 6 weeks.
After 6 weeks you will come out of the sling and start gentle movements, guided by a physiotherapist.
It may take 5-6 months for maximal function to be achieved.
Benefits: increased function and strength within the shoulder. Decreased pain.
NB: additional steps may also be performed at the same time as rotator cuff repair e.g. biceps tenotomy or biceps tenodesis; subacromial decompression; lateral clavicle excision.
Latissimus dorsi tendon transfer
This is used for very large tears that are not repairable in ‘younger’ patients who do not have arthritis. The tendon – muscle that gives the ‘V shaped torso’ is released off its insertion near the top of arm bone (humerus) and transferred to the location the rotator cuff tendon normally inserts (greater tuberosity). You will have an ‘L’ shaped incision at the back of your arm pit, plus an incision on the side of your shoulder.
Benefits: increased function and strength within the shoulder. Decreased pain. A transferred tendon generally provides 80% (4/5) power compared to a normal healthy tendon.
Risks: pain, swelling, bleeding, infection, stiffness, retear.
Anesthesia: General anaesthetic and a nerve block to help with pain relief. The numbness from the nerve block will wear off within 24 hours.
Duration in hospital: overnight.
After Surgery
Your arm will be in a sling for 6 weeks after surgery. Neck movements, shoulder blade shrugs, elbow and hand movements are encouraged. Try to avoid moving your shoulder (glenohumeral) joint during this period.
After 6 weeks you will come out of the sling and start gentle movements, guided by a physiotherapist.
Wound check at 2 weeks with Dr McGonagle’s practice nurse.
Review with Dr McGonagle at 6 weeks and 12 weeks.
It may take 5-6 months for maximal function to be achieved.
Reverse shoulder replacement (reverse shoulder arthroplasty):
Also known as Reverse Shoulder Arthroplasty. This is performed for ‘elderly’ patients with an irreparable rotator cuff tear +/- arthritis (cuff tear arthropathy). After surgery, movement of the joint no longer relies on the rotator cuff for movement. Instead, the large muscle on the side of the shoulder (deltoid) is responsible for shoulder movements.
Surgical planning is done with a computer program that uses information gained from a shoulder CT scan. This helps plan implant type, size and position.
You will have an incision at the front of your shoulder.
The cartilage surface on the top of the arm bone (humeral head) is cut off. The cartilage on the socket (glenoid) is removed and a metallic baseplate is screwed into the glenoid. A plastic (polyethylene) ball is attached to the baseplate. A metallic socket and stem is placed in the arm bone (humerus). ‘Reverse’ means that the orientation of the ball and socket is reversed.
Benefits: increased function and strength within the shoulder. Decreased pain.
Risks: pain, swelling, bleeding, infection, stiffness, weakness, dislocation, loosening, fracture
Anesthesia: General anaesthetic and a nerve block to help with pain relief. The numbness from the nerve block will wear off within 24 hours.
Duration in hospital: overnight
After Surgery
You will have an x-ray and blood taken the following morning.
Your arm will be in a sling for 6 weeks after surgery. Neck movements, shoulder blade shrugs, elbow and hand movements are encouraged. Try to avoid moving your shoulder (glenohumeral) joint during this period.
After 6 weeks you will come out of the sling and start gentle movements, guided by a physiotherapist.
Wound check at 2 weeks with Dr McGonagle’s practice nurse.
Review with Dr McGonagle at 6 weeks with an x-ray, and at 12 weeks.
It will take 6-12 months for maximal function to be achieved.