Torn Rotator Cuff – Frequently Asked Questions in Singapore

What is a rotator cuff and what does it do?

A rotator cuff is a group of muscles and tendons that attach the arm to the shoulder and help stabilise and move the shoulder. It has four main parts: the supraspinatus, infraspinatus, teres minor, and subscapularis.

Together, these muscles work to keep the ball of the arm in the socket of the shoulder, allowing you to perform everyday tasks like lifting objects or even just reaching up to grab something on a high shelf. It also helps protect the shoulder joint from injury.

 However, injuries can happen and rotator cuff injury is a common cause of pain and disability among adults. It can cause you to experience a dull ache in the shoulder, which often worsens with the use of the arm away from the body.

This also means that various daily activities like combing your hair or getting dressed may become painful and difficult to do.

What causes a rotator cuff tear?

A rotator cuff tear is a common injury that occurs when the tendons that attach the shoulder muscles to the bones of the shoulder joint are damaged. This typically refers to a rip in the group of four muscles and tendons that stabilise your arm’s movement.

There are two kinds of rotator cuff tears – partial and complete tears. A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged while a complete tear is when the rip goes all the way through the tendon or pulls the tendon off the bone.

Meanwhile, a worn rotator cuff that tears is known as a degenerative tear. This usually occurs over time from normal wear and tear, or if you are required to repeat the same arm motion over and over.

Aside from the normal wear and tear, a rotator cuff tear can also be caused by:

• Occupation – People who perform jobs like painting and/or heavy lifting usually have a higher risk of tearing their rotator cuff.

• Lack of blood supply – As you grow older, you get less blood to your rotator cuff area, making small tears difficult to repair which can lead to larger tears.

• Bone spurs – Bone overgrowth in the shoulder, which occurs as you age, can wear away the rotator cuff tissues and cause tears.

• Age – As you get older, your risk of a rotator cuff injury increases and are most common in people older than 60.

• Family history – There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

• Athletics – Certain sporting activities like baseball, tennis, rowing and weightlifting can put stress on the rotator cuff, increasing the risk of a rotator cuff tear.

How to know if I have a torn rotator cuff?

The pain from a rotator cuff tear usually starts gradually and worsens as time goes on. It may feel like a dull ache or it may feel like someone is poking you with their finger. Besides, you can’t always feel a torn rotator cuff.

However, in some cases, you might:

• Feel pain when lifting and lowering your arm or with specific movements.

• Experience some weakness when lifting or rotating your arm.

• Feel pain while resting and at night, especially if you’re lying on the affected shoulder.

• Have trouble raising your arm.

• Hear some clicking or popping sound when you move your arm.

When do I need surgery for a torn rotator cuff?

Treatment for rotator cuff injuries usually differs based on the severity of the tear. If you experience some of the symptoms above, your doctor is likely to start with a combination of several non-surgical treatments such as:

• Physical therapy to strengthen your shoulder muscles.

• Medications and anti-inflammatory drugs to reduce pain and swelling.

• Making modifications to your daily activities.

• Getting enough rest to let your rotator cuff heal.

• Steroid injections to provide temporary pain relief.

If these non-surgical treatments fail to relieve the symptoms of your rotator cuff injury, you may need surgery as most rotator cuff tears cannot heal on their own. Your doctor will likely need to stitch together the torn area or reattach the tendon to the bone.

In some cases, they may need to take out small pieces of tendon or bone that are stuck in your shoulder joint, or remove small areas of bone or tissue to give your tendon more room to move.

By opting for a rotator cuff surgery, you’re increasing your chances of regaining full range of shoulder motion while relieving the pain and swelling caused by the tear.

There are several types of surgeries for treating rotator cuff injuries:

• Arthroscopic tendon repair – Your surgeon will insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.

• Open tendon repair – Your surgeon will work through a larger incision to reattach the damaged tendon to the bone.

• Tendon transfer – If the torn tendon is too damaged to be repaired, your surgeon may decide to use a nearby tendon as a replacement.

• Shoulder replacement – Severe rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint’s stability, an innovative procedure installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.

How long does it take to recover from a rotator cuff surgery?

Depending on the type of surgery you opt for, recovery will take time and you will be required to keep your arm in a sling for 4-6 weeks to keep your shoulder as still as possible and support the weight of your rotator cuff.

Your doctor will likely advise you to get help from family members or friends with your daily tasks such as getting dressed, bathing, or even feeding yourself. Driving will be off-limits for at least a month.

After 6-12 weeks, your doctor may clear you for occasional lifting as long as you don’t try lifting anything overhead because your tendon is still healing. At this point, you may be allowed to return to your desk-based work while jobs that require heavy lifting or manual labour will only be allowed 3-6 months after surgery.

Physical therapy will be a key part of your recovery. Your therapist will give you some exercises to do at home everyday. The movements you learn will help you regain your shoulder strength and range of motion.

At Spire Orthopaedic Centre, we believe that everyone should be cared for and healed holistically in comfort without having to travel to different locations to seek medical and surgical help and rehabilitation support.

With a combined facility for collaboration between physicians, physiotherapists, and surgeons, you will experience a seamless service from diagnosis to treatment and rehabilitation, that’s tailored just for you at our clinic. Contact us now!