Rotator Cuff Tear
What is a rotator cuff tear?
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The muscles from the shoulder blade attaches to the head of the humerus to stabilise the shoulder joint.
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Tears can develop due to normal ageing and does not always need treatment unless they case persistent problems.
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Tears that happen due to significant injuries in relatively young (less than 65y) and healthy, often need repair.
How does it present?
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Often there is an aggravating event such as a fall or very heavy lifting
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It is painful to lift the arm overhead.
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Lifting items away from the body is usually uncomfortable
What can be done?
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Acute tears after a significant injury in a healthy individual usually needs surgery
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Chronic tears (that have become painful without a specific injury, unusually simply due to increased use) often can be treated without surgery.
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In older individuals (over 65) and/or in people with significant medical problems (poorly controlled diabetes, severe heart or lung problems, smokers etc.) even acute tears are treated without surgery.
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Treatment without surgery usually consists of.
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–Avoiding activities that hurt
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–Gentle physiotherapy
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–Anti inflammatories
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–Steroid injections
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When is surgery needed?
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Acute tears in young, healthy individuals, or
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Where non operative treatment is unsuccessful and
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The injury stops you from doing the ‘things that you have to do’ such as getting dressed, making a meal, driving a car, or getting a good night’s sleep
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and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read
How does surgery work?
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This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)
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Often the anaesthetist does a nerve block (that numbs and paralyses the arm for about 12 hours) to help with pain relief – it can be very painful surgery.
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Because it can be quite sore immediately after surgery - It is recommended to stay in hospital overnight
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Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.
What do we do in surgery?
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Surgery usually takes about 1-2 hours
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But the whole process of going to theatre and waking up from surgery takes longer.
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Often the surgery is done with the help of a camera (arthroscopic, or ‘keyhole’).
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Sometimes a larger skin cut is needed to do a strong repair
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The torn tendon is cleaned and sutured back to bone with anchors
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If the biceps tendon is damaged, it sometimes has to be released from inside the shoulder and reattached to the humerus.
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If there is a large spur in the shoulder it is removed
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If the AC(acromioclavicular) joint is very arthritic and painful it is resected
After the Surgery
In Hospital
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The wounds are dressed and the arm is placed in a sling
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We often leave a pain catheter in the shoulder to deliver more local anaesthetic at about 10 hours after surgery (when the anaethetist’s nerve block starts to wear off)
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Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
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It is usual to leave hospital the morning after surgery
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A physiotherapist will usually visit you in hospital to demonstrate gentle exercises.
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At Home
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Continue to stay on top of your pain with oral pain killers.
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Do the gentle exercises that physiotherapist demonstrated in hospital. It is usually advised to see a physiotherapist in the community at around 4-6 weeks post surgery.
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It is OK to remove your sling to do these exercises, but in most cases it should stay on at all other times for 6 weeks.
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While the shoulder wounds are covered with waterproof dressings it is safe to have a shower. Please have the dressings replaced if they start to come loose.
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An appointment is usually made at my rooms to review your progress at about 2 weeks after the surgery
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Please do not drive before speaking to your physiotherapist or a doctor.
The recovery
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A sling is usually worn full time for about 6 weeks
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From around 4 weeks on, a physiotherapist will show you how to start to progress your range of motion exercises.
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From 6-12 weeks sling wear can be weaned shoulder movements increased under physio supervision.
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Most moderately activities can usually be achieved by 3-4 months, but it will take 6 -9months to become completely comfortable and to return to maximal effort.
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It often takes up to a year to regain completely normal range of motion.
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Time frames
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Self care (washing, dressing, eating) with the operated hand – usually around 4-6 weeks (a sling is still needed)
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Driving: when you are able to control a steering wheel with your operated arm and you are not taking strong pain relief anymore (usualy 6-8 weeks post surgery)
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Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)
What can go wrong?
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Infection occurs rarely (1% of the time), but can be severe. It may need further operations, weeks in hospital. It can lead to a poor outcome.
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There may be ongoing pain from other worn-out joints in the area, that were not obviously a problem at the time of doing the surgery.
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It is common to have a bit of numbness next to the scar. Very rarely, severe nerve damage can occur, resulting in paralysis or numbness in the arm.
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Around 10-15% of the time more than expected stiffness occurs in the shoulder (frozen shoulder). It can take 2 years or more to get better.
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The reconstruction can fail, may not heal completely, causing ongoing pain in the shoulder. Some studies have shown that it occurs in up to 20% cases.
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A general anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.
What can you expect the final outcome to be?
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The biggest majority of patients experience significant improvement in their shoulder pain and function.
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Mild discomfort and stiffness commonly persist despite successful surgery.
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Strength usually recovers, but it can take up to 2 years to reach maximal improvement.
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Tendons that were worn before the surgery will tend to tear again over the years after the surgery
FAQs
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How long will the surgery take / How long will I be in hospital?
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–about 2 hours, overnight
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Which hospital?
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–The Sunshine Coast University Private Hospital
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–Or Kawana Private Hospital
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Anything I should do to prepare for surgery?
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–You should make sure that you have no pimples or skin breaks around your shoulder.
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–if there are any pimples it should be washed with benzoil peroxide.
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–Stop any drugs or supplements that may cause thinning of blood (anti inflammatories, fish oil etc.)
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–Make sure that you have help at home for after surgery; you will need a sling for 6w and cannot drive for at least 6w
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–don't smoke
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After care - showering, etc
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as long as waterproof dressings are securely in place
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Will I be in a sling?
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–yes for 6w
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Worst case scenario
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–You can get a frozen shoulder that can take 2 years to recover.
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–The reconstruction can fail (and needs to be re done), or never be any good (uncommon in young healthy individuals.
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–Infection can make the shoulder worse than it is now, it may never recover (there is less than 1% risk of this happening)
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–Very rarely serious complications can occur from the anaesthetic, such as a stroke or heart attack.
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Rehab - Who / Where?
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–first month: gentle exercises as demonstrated in hospital by physio
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–After that please see a physiotherapist in the community to help with further rehabilitation.
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WC have requested a medical table of costs – what is that?
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–We usually send a request for surgical approval to Workcover, it contains the item numbers(fees) that will be used.
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