Rotator Cuﬀ Tear
What is Rotator Cuff Tear?
The shoulder joint is a ball and socket joint between the shoulder blade (scapula) and the upper arm bone (humerus). I basically looks like golf ball sitting on a tee. A group of muscles coming from the shoulder blade crosses the joint as tendons and inserts into the humerus. This complex of tendons is called rotator cuff. A number of factors can lead to defects and tearing of the rotator cuff tendons.
What are signs of Rotator Cuff Tear?
Chronic shoulder pain, often worse at night, is a common symptom. Due to the defect in the muscle-tendon-unit weakness and early fatigue are typical and the arm can only be raised with difficulty. In severe cases the arm cannot be lifted at all. This symptom is known as ‘dead arm syndrome’ or ‘pseudoparalysis’.
Who gets a Rotator Cuff Tear?
Most commonly the tear is of degenerative nature and middle aged patients often present with Rotator Cuff Tear. Long standing, chronic subacromial impingement syndrome can, if left untreated, progress to Rotator Cuff Tear. The impingement can lead to attenuation of the rotator cuff tendons and a subsequent tear. Direct trauma or shoulder dislocation can also be causes of Rotator Cuff Tear.
How will Rotator Cuff Tear be investigated?
Patient history and clinical examination will reveal typical signs of Rotator Cuff Tear. Imaging studies (Ultrasound, radiographs, MRI) will show Rotator Cuff Tear. Please bring recent and relevant studies with you to your initial appointment.
Treatment of Rotator Cuff Tear
Non operative measures such as pain medication, anti-inflammatories and physiotherapy often help to ease pain and improve function. Cortisone injections should be considered rather carefully as these are only indicated in a select group of patients.
Surgical Rotator Cuff Repair
Once progress plateaus surgical Rotator Cuff repair is an option. The procedure is most often done via keyhole surgery (arthroscopy). It involves:
- Four or five 5mm incisions around the shoulder joint
- Cleaning of torn tendon edges and bone
- Reattaching the tendon to bone with sutures
- Overnight stay in the hospital for optimal pain management
Preparing for Rotator Cuff Repair Surgery
Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.
Recovery after Rotator Cuff Repair Surgery
The shoulder immobiliser will be fitted after the surgery and a continuous cooling cuff will be placed. Depending of the size of the tear and the extent of repair immobilisation will be required for two to six weeks. Physiotherapy will commence 48 to 72 hours after surgery and will focus on making you comfortable and keeping the shoulder mobile. Once shoulder immobilisation has been ceased physiotherapy aims to increase range of motion and improve strength. A gym based strength and resistance program supervised by an exercise physiologist will follow. Full recovery to pre-injury mobility and strength will take several months.
Rotator Cuff Repair - Collagen Repair Patch Augmentation (Regeneten®)
Is there anything that facilitates faster recovery after rotator cuff repair and reduces complications?
The short answer is: “Yes - there is!” It is called ‘Regeneten®’ and it is a patch of collagen. It is made out of bovine achilles tendon which is reconstituted meaning all that’s left over after processing is collagen. This patch is used to augment a rotator cuff repair or a partial rotator cuff tear. It can be applied via arthroscopy (keyhole surgery) meaning no additional incision is required other that the three or four small ones for the repair.
Internationally Regeneten® has been successfully implanted since 2014 and in Australia since 2016.
It has been researched with published results of an Australian study showing that it makes rotator cuff healing after repair less likely to fail as it decreases the time required for healing. Other complications such as stiffness (frozen shoulder) and pain are also significantly fewer.
Regeneten® currently requires TGA (Therapeutic Goods Administration) exemption approval as it has not yet been labelled with a rebate code. Therefore health insurers don’t cover the device and it adds to the patient’s out of pocket expenses.
Please ask myself or our reception staff for further information.