Rotator Cuff Tear
We’ll help you return to your everyday life as quickly as possible
Are you finding that normal everyday activities such as brushing your hair, carrying shopping bags or putting on your coat are suddenly difficult to do? This may be due to a rupture of the rotator cuff in your shoulder, or a rotator cuff tear.
The consultants and orthopaedic specialists at Schoen Clinic have specialised in treating shoulder disorders and injuries for many years. Through our experience, we’ll help you get your normal life back as quickly as possible.
What is a rotator cuff tear?
The shoulder joint is the most flexible joint in the body. It’s made up of the humerus head and the joint socket. Compared to other joints such as the knee or hip, the shoulder joint is only loosely secured to the bones: muscles, tendons and ligaments, in conjunction with the joint capsule, are primarily responsible for the crucial task of stabilising the joint.
A special group of four tendons in total ensure that the joint is directed with strength and stability and, most importantly, that it’s centred. This group of tendons is called the rotator cuff because they lie on the humerus head like a cuff. The rotator cuff muscles that run from the shoulder blade to the humerus bone (the subscapularis muscle, the supraspinatus muscle, the infraspinatus muscle and the teres minor muscle) move the arm up and to the side, turn it outwards and inwards and stabilise the arm on the torso.
These tendons run directly around the joint along a narrow bony canal between the humerus head and shoulder cap. Wear and tear can occur over time, especially in the supraspinatus tendon, and this is unnoticeable at first. In extreme cases, a hole or tear in the tendon can occur. This also typically affects the supraspinatus tendon in particular.
Rotator Cuff Tear Symptoms
How does a rotator cuff tear occur?
From falls to sports injuries and even heavy lifting, there are many causes behind a rupture of the rotator cuff. While just around 5% of tendon tears in the shoulder joint occur as a result of an accident in younger patients, rotator cuff ruptures due to degeneration are much more common, making up approximately 95% of cases. In this instance, the tendons have already been damaged due to wear processes and have thereby lost some of their stability. Just a minor fall or forceful ordinary movement is enough to finally injure the already damaged tendons.
Symptoms that are signs of this injury
Many patients with a rotator cuff tear report a dragging or stabbing pain in the shoulder region that can radiate to the neck area or even the hand. This pain is typically even more severe at night, restricting the ability to have a good night’s sleep. Losing tension in these muscles and the ability to automatically maintain posture leads to significantly reduced mobility. In particular, moving the arm forwards or to the side will no longer be possible. This has far-reaching consequences. Those affected are severely limited in their everyday life, so their quality of life is reduced. They can no longer handle everyday activities that seemed normal before, such as brushing their hair or carrying shopping bags, or they can only complete them with great effort.
Diagnosis: how we determine a rotator cuff rupture
A functions test provides us with the first signs of a tendon tear. In this test, our specialists examine and assess the mobility and strength of your shoulder. In the case of a rotator cuff rupture, you’ll normally no longer be able to move your arm forwards or to the side. In addition, there’s often a loss of strength as well. A lot of those affected report having pain at night after the injury – they are barely able to lie on the arm.
Imaging procedures for examining the shoulder
We can only accurately assess the bony structures using x-ray. But because a rotator cuff tear involves an injury to the muscles and tendons, other imaging procedures are often used during diagnostics. X-ray images are still very important when diagnosing a rotator cuff tear – only x-ray images can be reliably used to determine whether the rotator cuff still directs or centres the humerus head stably in the joint. MRI performed with patients in the supine position cannot provide this information.
Ultrasounds and MRI show destroyed structures
Using ultrasound examination (sonography) and magnetic resonance imaging (MRI), we can analyse the status of the soft tissue inside your shoulder. Ultrasounds allow for clear images of the tear in your muscle and tendon apparatus. Changes to the tendons and any effusions inside your shoulder joint are also visible.
MRI examination offers the most accurate view of the affected joint. This presents the joint in high resolution, allowing us to reliably establish which structures are damaged.
Rotator Cuff Tear Treatment
Different factors determine treatment
If a tear in the rotator cuff has been diagnosed, there will of course be different therapeutic approaches to consider based on the severity of the damage and extent of the shoulder injury. So selecting the right type of treatment will depend on how the injury occurred, how much this restricts you and how much independence you want, among other things. Your age also plays an important role. For younger patients or more recent tendon tears, the stability of the shoulder is typically restored through surgery. But because wear-related rotator cuff defects often occur in older people and sometimes only cause mild symptoms, extensive reconstruction will need to be carefully considered,
along with your individual life circumstances, everyday requirements and sports activities.
Conservative treatment methods
Conservative treatment through immobilisation and medication
With conservative treatment, the focus is on temporary protection, decongestant and painkilling medication, localised applications of ice or heat and special physiotherapy exercises. Through this, we can achieve a situation where you pain-free or have reduced pain, with as much shoulder functionality as possible. You can preserve the mobility of your shoulder in the early stages using arm pendulum exercises (rotator cuff exercises). If any swelling occurs, our therapists can help relieve this using manual lymph drainage. In addition, additional physical applications such as massages or electrotherapy can support the healing process.
Surgical treatment methods
Rotator cuff tear surgery: making your shoulder pain-free again
If conservative treatment has no chance of success, we’ll need to repair the damaged structures in your shoulder through surgery. This is the only way we can prevent further damages in the joint. Our joint specialists proceed with the operation using minimally invasive methods where possible. With arthroscopy, for example, only very small skin incisions are required. This way, we can treat the injury to your joint while also continuing to preserve your tissue.
Before deciding on rotator cuff tear surgery, we always have an open conversation with you. Why? Surgical restoration of the rotator cuff often involves lengthy aftercare. It typically takes several months before the operated tendon tissue heals again. Surgery therefore always creates restrictions in your working life.
Arthroscopy and open surgery of the shoulder – both are possible
We can treat a rotator cuff tear using either the keyhole technique (arthroscopy) or open surgery. Both procedures can also be combined. This way, we can protect the torn tendon parts and safely reattach them as part of a quick surgical procedure.
With arthroscopy, we operate on your injury using a small (minimally invasive) skin incision, protecting the tissue as much as possible. Because the surgical wound is only very small, less scarring forms and the healing process is very quick. Furthermore, we can precisely assess the extent of the damage in your shoulder joint during this procedure and carry out additional treatment steps as needed.
Artificial tendon replacement (SCR): patching the tendon defect
If the rotator cuff defect is too large, the tendon pulled back too far and the muscles too fatty and degraded, the tendon tear won’t be able to close up successfully. This creates the risk of no longer having a centring function and of the humerus head sticking out under the shoulder cap, limiting the function of the shoulder.
In such cases, up until the last few years, the only option was to implant a reverse shoulder replacement. But because the lifetime of this replacement is limited, this procedure was postponed, especially for younger patients under 60 years who were still very active physically.
In the last few years, however, a technique has been developed that has already demonstrated very good mid-term results. This involves closing the tendon defect using a type of patch. Foreign skin from the tissue bank is suitable for this patch, but one of the body’s own surface tendons of the thigh is also increasingly being used as this is four times more similar to the substance of the rotator cuff. This is removed through two 3cm long incisions of the thigh, which doesn’t cause any pain for patients.
Muscle-tendon transfer as a mechanical replacement
Another option for closing tendon defects that can no longer be repaired is a muscle-tendon transfer. Here, a back muscle tendon (latissimus transfer) is placed from the front-inner part of the upper arm to the top-outer part. However, only patients under 60 years are able to retrain this muscle for its new function to a good extent, and the aftercare and restoration of activities takes a very long time: three to six months.
Implantation of a total reverse shoulder replacement: reduction of pain and restoration of active movement
If the joint shows damages on the surface alongside the rotator cuff tear, the humerus head under the shoulder cap will have the same lack of function as the shoulder joint. In this case, implantation of a reverse shoulder replacement is a good alternative, especially for patients aged over 65 years. Modern reverse shoulder replacements can often be anchored to the humerus while preserving the bone structure without the use of cement or a shaft, and are inserted through a 7-8cm long incision that protects the soft tissue. 85% of these implants currently have a lifetime of 15 years, but there are also replacement options. The benefit of these implants is the relatively short aftercare duration. Because no tendons need to grow back, you’ll be able to have good mobility in your shoulder joint again three to six weeks after surgery.
The hospital stay lasts four to seven days. You’ll start passive movement exercises to quickly regain joint mobility straight after the procedure. Inpatient or outpatient rehabilitation treatment is recommended after three to four weeks.