Rotator Cuff and Other Tears

Common signs of rotator cuff injury include:

  • Swelling and pain in the front of the shoulder and side of the arm
  • Pain felt when raising or lowering the arm
  • A clicking sound when raising the arm
  • Stiffness
  • Pain that causes you to wake from sleep
  • Pain when reaching behind the back

What is the treatment?

  • Steroid injections, anti-inflammatory medication and physical therapy may all be useful in the treatment of rotator cuff tears. Even though most tears cannot heal on their own, good function can often be achieved without surgery.
  • If, however, you are active and use your arm for overhead work or sports or have pain, then surgery is usually recommended because many tears will not heal without surgery and may get larger with time. Surgery is generally recommended if you have persistent pain or weakness in your shoulder that does not improve after several months of non-surgical treatments.
  • Surgery is also generally recommended when the tear is large (more than 3cm) and often recommended when the tear is caused by a recent, acute injury or getting larger on serial scans.

What does surgery involve?

  • During a rotator cuff repair, the tendon is reattached to the tuberosity bone of the humerus from which it has been torn. This is done using suture anchors in minimally invasive, arthroscopic fashion.
  • Bone spurs can also be removed in a similar fashion to prevent further tendon injury. Being a completely arthroscopic surgery, rotator cuff repair surgery is now a more minor procedure than it used to be and is often done as a day surgical procedure.
  • The recovery however, still often requires a sling for 6 weeks to protect the repair until it heals.

 

                                                                                        Other Shoulder Tears

Labral Tears

A shoulder joint labral tear is an injury to the labrum of the shoulder, or to the fibrous ring surrounding the glenoid or socket of the shoulder. When the labrum (made of fibrous cartilage tissue) is torn, it can make the shoulder unstable and cause the shoulder to dislocate. Labral tears are often caused by:

  • Falling on an outstretched arm
  • Falling on a shoulder
  • Bracing with your outstretched arm in a car accident
  • Lifting heavy objects repeatedly or too suddenly
  • Doing a lot of overhead activities, such as throwing a baseball

There are several different types of labral tears:

  • A labral tear above the middle of the socket is called a SLAP Tear. Slap tears occur at the top of the shoulder (11 o’clock to 1 o’clock).
  • If the tear is at the front of the shoulder, it is called a Bankart Tear  (3 o’clock to 6 o’clock)
  • When the tear is at the back of the shoulder (6 o’clock to 11 o’clock it is known as a Reverse Bankart Tear
  • Sometimes tears occur in combination and these tears are called 270 degree tears.

What are the symptoms?

  • Pain with overhead movements like throwing a ball
  • Popping, clicking, or catching in the shoulder
  • Pain when you move your arm over your head or throw a ball
  • Weakness or instability in the shoulder
  • People often have a hard time describing or pinpointing where the pain is or describe it as an “aching” pain.

 What is the treatment?

  • Usually, a significant labral shoulder tear will need surgery for the best outcome and function. This is generally done via a minimally invasive procedure known as arthroscopy, which can be done as a day surgery. Physiotherapy will be required post surgery.

Biceps Tendon Tear at the Shoulder

What is it?

  • The biceps muscle has two tendons at the shoulder; a long head and a short head. At the distal end there is one tendon which crosses the elbow. The biceps muscles allow you to bend the elbow and pronate (rotate) the arm.
  • At the shoulder, the long head biceps tendon attaches to the top of the shoulder socket, and the short head biceps tendon attaches to the coracoid process.
  • Proximal biceps tendon tears can be partial or complete and most often associated with incomplete tears of the long head of biceps tendon.
  • A complete rupture will result in a “Popeye Deformity” where the bicep bunches up and bulges out like Popeye’s arms.

 

What are the symptoms?

  • Popping sounds at injury
  • Pain, tenderness and weakness at the shoulder or elbow
  • Trouble turning the palms face up or face down
  • Bruising
  • Bulging above the elbow
  • Sharp and sudden upper arm pain

 What is the treatment?

  • While you may be able to live with a Popeye deformity of a proximal biceps tendon tear, a distal biceps tendon tear needs prompt treatment as the distal biceps tendon can retract from the bone and cannot heal itself.
  • Permanent weakness can occur if the tendon is not repaired surgically and a deformed and high riding biceps muscle can cause you to lose more than half of your elbow strength.
  • For these reasons, surgical repair is most effective within first two weeks of symptoms. There is about a 3 month recovery post surgery.