When is surgery an option?
Almost all but the worst RCT tears can be treated by hands on therapy such as NAT and exercise. Exercises include range of motion and daily stretching plus specific strengthening exercises (performed 3-4 x week using latex or REP band). Avoid overhead activities or movement into the painful range. NSAIDs may provide some relief, although our experience is that often very little helps the night pain when present. Ice can be useful for pain relief. BUT if there is no improvement in 2 to 3 months, a subacromial injection of corticosteroids can be tried and if this fails surgery may be employed.
What are the surgical options?
RCT surgery mainly involves putting 1-3 attachment screws into the shoulder and arm bones and then re-attaching/anchoring the tendon to theses screws. The biggest issue is that the damaged tendon is often frayed or damaged. Over time the damaged tendon retracts and shortens and there is often not healthy tissue to anchor to; surgery in these cases this may lead to temporary benefit but often (more than 50%) ends in failure over time surgery may need to be repeated.
The choice of surgery relates to the specific patient and severity of the condition; the two main surgical techniques are:
Arthroscopic (keyhole) or Open surgery
The advantages of Arthroscopic surgery are:
Reduced post-operative pain
Reduced time in hospital
Reduced wound complications
Quicker recovery time (for work and sports)
Usually self dissolving stitches
What are the typical results / recovery period?
You will need to use a shoulder support sling for at least 3 weeks, mainly when going out and for sleeping. It can be removed for dressing and bathing but means very limited activity.
Time-off work depends on your job but ranges from 3 weeks for minor tears, to as much as 6 months for heavy work duties. Physical therapy for several months after the surgery.
What type of rehabilitation do I need?
You will need to follow a very carefully constructed rehabilitation programme with a physical therapist and possibly work with an occupational therapist. You will also need to do homework.
Post surgical improvements continue up to one year and you should continue exercising until your maximum potential has been reached.
|Lifting||Can begin at three weeks. Avoid heavy lifting for 3 months|
|Return to work||3 weeks for Sedentary job. Up to 6 months for manually intensive works|
Rotator Cuff Tendinopathy (RCT) is one of the most common causes of shoulder pain and weakness
What is rotator cuff tendinopathy (RCT)?
Rotator cuff tendinopathy (RCT) is one of the most common causes of shoulder pain and weakness. Interestingly, most of the current evidence points away from swelling of the tendons and towards internal damage and thinning/weakening as the cause by as much as 95%. It can lead to a range of symptoms, from pain to pinching and is often associated with night pain and decreased range of motion in certain positions.
Mechanically, the rotator cuff has been designed to stabilize the shoulder ball and socket during activity. It pulls the shoulder ball and socket joint backwards and downwards helping to center the ball in the socket. The rotator cuff is made up of four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) whose tendons blend together to form a strong muscular cuff (for more information click here).
RCT often starts with a single pinched or damage tendon – research tells us this is most commonly the supraspinatus. This is yet another reason to get the impingement treated with manual therapy or NAT. Once it is damaged, the tendon gets overloaded and degenerates causing mechanical failure. We classify it as primary (genetic) or secondary (due to prolonged micro-trauma and tearing). Also we tend to find that other more superficial shoulder muscles start to over work causing neck and pain in the opposite shoulder from overuse. RCT is often misdiagnosed as a frozen shoulder / frozen shoulder syndrome.
Why does it happen?
We now know that muscles can get old and worn in a similar way to bones, this is called “peri-arthritis”. Certain muscles are more prone to this and supraspinatus is one of the prime examples. Repetitive micro-trauma causes small bleeds inside the muscle substance and the body attempts to repair these at night when the body is resting – thus leading to night pain. There are a number of risk factors:
What treatments are available?
Treatments range from hands-on to surgery depending on who you see and how bad the damage is. Whilst the cuff can be diagnosed and assessed by some relatively simple techniques, we would recommend you to get an ultrasound or an MRI to assess the extent and location of the damage. Damage can range from a small single muscle tear all the way through to a complete cuff tear. The treatment approach will vary according to these results.
It is important to get treatment from a well-qualified and knowledgeable practitioner as soon as possible because the longer you leave it the worse it can get. Don’t panic, mild to moderate and even some severe rotator cuff injuries can be effectively treated by simple hands-on techniques such as NAT or manual therapy plus a specific rotator cuff strengthening exercise regimen. We have included some exercises here but recommend you go through them at least once with a qualified professional.