Rotator cuff tears

Rotator cuff tears are a common cause of shoulder pain.  Some patients will recall a significant injury, and they can be sustained after a sporting injury.  However, the majority of patients who sustain these injuries are older than 50, and will not recall any specific injury.

Rotator cuff tears cause pain in the shoulder region, typically when moving the shoulder, or at night when sleeping.  An MRI is very accurate at diagnosing the injury.

Many tears can be well management with physiotherapy and exercise.  This involves internal and external rotation exercises, using a theraband or pulleys for resistance, aiming to strengthen the muscles and tendons in the shoulder which are not torn. Posterior capsular stretching, as taught by physiotherapists can also help.  Cortisone injections can also help settle the inflammation, are very safe, and do not damage the tissue.

Patients who have full thickness rotator cuff tears, who still have significant pain after a year, who cannot sleep at night, and in whom physiotherapy and injections are not helping, can be a candidate for surgery.  Rotator cuff repair is performed using arthroscopic or keyhole techniques.

For more information, please see Dr Dwyer’s online textbook:

www.boneschool.com/rotator-cuff-tears

Postoperative rehabilitation

Shoulder surgery is performed as day surgery at Women’s College Hospital. Someone must come and pick you up and take you home. It is advised to have someone around to help you for the first two days. All patients will be provided with a script for medications that should be filled at the hospital prior to going home. Medications will usually be Celebrex in the morning for 2 weeks, Aspirin at night for two weeks, and Tylenol regularly for the first week. A script for oxycodone will also be provided.

All patients will wear a sling to sleep and walk for 6 weeks after surgery. After one week, the sling can be removed when sitting in a chair, and patients are allowed to use a computer, keyboard, and mouse. Physiotherapy usually begins 6 weeks after surgery, once the shoulder is pain free, and the risk of retear is low.

If possible, patients should rent a Gameready machine, which provides ice and compression to the knee, significantly reducing postoperative pain. The information for the rental company will be provided to you. Patients are seen in clinic two weeks after surgery, for wound review. 

Patients should take a week off work after the surgery. Patients are not allowed to play sport for 6 months after surgery.

Risks of surgery

Arthroscopic rotator cuff repair is a relatively safe operation, with a 1/1000 risk of deep infection, major stiffness, DVT/PE, or major nerve or blood vessel damage. Patients can get local areas of numbness around the incisions, which typically improves over a year or two.

Approximately 95% of patients report a good to excellent outcome after six months.  Patients are usually 80 – 90% better, and glad they had the surgery.The risk of retear approximately 5% – this is minimized by being in a sling for 6 weeks, and rehabilitating appropriately for 6 months.  All patients after this surgery

should attempt to minimize heaving lifting, and any repetitive lifting above shoulder height for the foreseeable future, to reduce the risk of retear.