The rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals. It may occur with repeated use of arm for over head activities, while playing sports or during motor accidents. Genetic make-up also has a significant part to play. Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
Rotator cuff tear is best viewed on magnetic resonance imaging. Symptomatic relief may be obtained with conservative treatments – rest, shoulder sling, pain medications, steroidal injections and certain exercises. However surgery is required to fix the tendon back to the shoulder bone. Rotator cuff repair is usually performed by an arthroscopic (keyhole) procedure. Occasionally open surgery is required. During the procedure, space for the rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery your arm will usually be strapped onto a pillow. This is used to rest the arm and to allow the soft tendon to regain strong and long-lasting attachment to the bone. This pillow is used for the first 5 to 6 weeks. It can come off for showering, but is usually worn whilst sleeping. Gentle hand use is allowed, however active shoulder movement in those first six weeks is discouraged. The next six weeks see the gradual introduction of assisted range of movement exercises. At three months, stronger exercises and range of movement activities are encouraged. It can take 6 to 9 months to plateau. The usual outcome is a much more comfortable and stronger shoulder, with useful range of movement. The extremes of range of movement may be lost, because of the effects of the body’s scar tissue formation.