Download Rotator cuff tears - East Kent Hospitals

Rotator cuff tears
Information for patients from the Physiotherapy Department
If you have been diagnosed with a rotator cuff tear this leaflet will explain what a rotator cuff tear
is, the associated signs and symptoms, and how it can be diagnosed. Although the exact method
of treatment will differ from patient to patient, the most common treatment techniques and their
likely outcome are also covered.
What is a rotator cuff tear?
Rotator cuff tears are among the most common causes of shoulder pain and disability. The “rotator
cuff” is made up of four muscles and their tendons, which connect the shoulder blade to the
humerus (upper arm bone) forming the shoulder joint. One of the key roles of these muscles is to
stabilise or hold the shoulder joint in place when we use our arms. The strength of these tendons
allows the humerus to be lifted and rotated.
The shoulder joint is a very mobile joint to allow it to be used for a wide range of movements. As
such, the stability of this joint is compromised requiring the rotator cuff muscles to work hard. As
we age it is normal for the rotator cuff tendon to wear and helps to explain why rotator cuff tears
(partial or complete) are more common later in life (over the age of 40 years).
What are the signs/symptoms?
• Pain is usually experienced in the shoulder area.
• A “catching” sensation may be felt when you move your arm in particular directions.
• Difficulty sleeping on the affected side, due to pain.
• Weakness in the affected shoulder, although this depends on the size of the tear. Usually a
complete tear is very obvious, since when your arm is raised above your head you will not be
able to smoothly lower it to your side. Generally, the larger the tear, the more weakness it
causes.
• Sometimes popping/clicking can be felt over the shoulder.
• Sometimes neck pain can accompany shoulder pain.
Despite the fact that some people experience painful symptoms with rotator cuff tears, many
people will have a tear with no symptoms or disability.
A rotator cuff tear is often associated with previous shoulder problems, although occasionally
individuals who have never had any previous shoulder problems may develop a tear due to a fall
or injury.
How will a rotator cuff tear be diagnosed?
A physical assessment by a doctor or physiotherapist is helpful in diagnosing a rotator cuff tear.
This will involve looking at particular movements of your shoulder and assessing it for any pain/
weakness. Additionally your health professional may request one of the following to confirm their
diagnosis.
• X-ray - although x-rays will not show tears in the rotator cuff, other findings associated with
rotator cuff tears may be evident.
• Ultrasound scan uses high frequency sound waves, inaudible to the human ear, to create
a computer image. An ultrasound scan is a useful way to examine the muscles, ligaments, soft
tissues, and joints of the body.
• MRI (magnetic resonance imaging) scan uses magnetic waves to create pictures of the
shoulder in slices. The MRI shows soft tissues (muscles, tendons, ligaments) as well as bones
and is a painless procedure not involving needles/injections.
What are the treatment options available?
• Medication
The doctor may prescribe painkillers or anti-inflammatory medications to help ease the pain. It
is important that you consult your doctor regarding the appropriate type of medication.
• Injections
Some individuals find a corticosteroid injection helpful to ease the pain. The needle is put
in to the space under the acromion (the front edge of the shoulder blade), not the tendon,
and a mixture of local anaesthetic and corticosteroid is injected into the space. You may initially
notice less pain due to the local anaesthetic, but then the shoulder may be more painful until the
corticosteroid takes effect.
With rotator cuff tears, sometimes the effects of corticosteroids do not tend to last very long and therefore they are not used regularly. When used, most doctors will not give more than three injections a year and if the symptoms do not settle down then other treatments may be recommended.
• Physiotherapy
Physiotherapy usually consists of an assessment of your shoulder, followed by advice and additional treatments to control pain and inflammation, such as heat or ice. Initially you will be
advised to avoid positions that cause pain and to try to balance activity and rest of the affected
shoulder. “Hands-on” treatments and various exercises are used to increase the shoulder joint
movement and prevent it from stiffening up. Exercises also aim to improve the strength and
control of the rotator cuff and shoulder blade muscles. Some physiotherapy departments may
also offer complementary treatments such as acupuncture to help ease the pain.
• Occupational therapy
Occupational therapy contributes to the rehabilitation of rotator cuff tears by providing
assistance with personal tasks (such as washing and dressing) and everyday activities (like
kitchen tasks). Therapy may involve teaching techniques which aid these tasks or by providing
a number of simple aids which can greatly improve quality of life. Examples include the helping
hand, jar grippers or aids for dressing.
2
• Surgical management
If your rotator cuff injury does not respond to these treatments after six to12 months you may
be offered surgery. A procedure known as a ‘mini-open repair’ is normally used. This involves an
arthroscope (like a mini-telescope) being inserted to visualise the tear, assess and treat damage
to other structures within the joint. Once this part of the procedure is complete the surgeon
performs a mini incision (three to five centimetres) to repair the torn rotator cuff.
You will still require physiotherapy following surgery. Initially this is restricted by the healing rate
of the rotator cuff, which will take approximately six weeks. A sling is required to be worn during
this time (four to six weeks) to allow the healing process to occur. Exercises at this stage are
limited, after which they can be increased appropriately; guided by your physiotherapist.
Your consultant or physiotherapist will discuss the options available to you before any treatment
begins. This will be a time for you to ask questions and/or express any concerns you may have
about your condition.
How can I help myself?
• In the acute (early) stage a bag of frozen peas wrapped in a damp tea towel placed over the
shoulder for 10 minutes at a time may help to reduce the inflammation and pain. Do not use
these peas for eating once defrosted.
• You may find it more comfortable to lift your arm away from your side with your palm up rather
than with your palm down, or you may find it helpful when lifting or lowering your arm to support
your affected arm with your unaffected arm.
• Try to avoid repetitive overhead activities until the pain settles.
• Try to improve your posture; hold your back straight and your shoulders back.
• If your symptoms are aggravated by a sport you may benefit from advice from a coach/
instructor regarding your techniques.
• Do not let your shoulder stiffen; make sure that twice a day you move your arm through the full
available range, or as pain allows. You can do this by lying on your back and lifting your arm
above your head using the unaffected arm.
Please consult your GP for appropriate pain management advice.
The outlook is good!
Many patients with rotator cuff tears manage well with non-surgical treatment, in about six to
eight weeks. Recent evidence shows exercise therapy has a better outcome in management of
rotator cuff tears. Where surgery is deemed necessary, there are similar success rates. However,
rehabilitation can be a slow process and you should expect full recovery to take up to six to 12
months. As recovery and rehabilitation is such an individual process, returning to work or normal
everyday activities should be discussed with your doctor/physiotherapist who will help decide what
is appropriate for you.
Glossary of terms
• Acromion: the front, outer edge of the shoulder blade, which forms the point of the shoulder.
• Arthroscopy: use of a small probe/telescope used to assess, examine, and repair tissues
within or around joints.
• Corticosteroid: a drug which reduces swelling or inflammation.
• Humerus: the upper arm bone between the shoulder and the elbow.
• Local anaesthetic: a drug which numbs a local area of body.
3
Further information
If you have any comments please do not hesitate to let us know by contacting one of the following
Physiotherapy Departments.
• William Harvey Hospital, Ashford • Kent and Canterbury Hospital, Canterbury
• Queen Elizabeth the Queen Mother Hospital, Margate Telephone: 01233 616085
Telephone: 01227 783065
Telephone: 01845 225544
For further information please go to www.shoudlerdoc.co.uk
Any complaints, comments, concerns, or compliments
If you have other concerns please talk to your doctor or nurse. Alternatively please contact our
Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314,
or email [email protected]
Further patient information leaflets
In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets
covering conditions, services, and clinical procedures carried out by the Trust. For a full listing
please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff.
After reading this information, do you have any further questions or comments? If so,
please list them and bring to the attention of your nurse or consultant.
Would you like the information in this leaflet in another format or language?
We value equality of access to our information and services and
are therefore happy to provide the information in this leaflet in
Braille, large print, or audio - upon request.
If you would like a copy of this document in your language, please contact the ward or department
responsible for your care.
Pacjenci chcący uzyskać kopię tego dokumentu w swoim języku ojczystym powinni skontaktować
się z oddziałem lub działem odpowiedzialnym za opiekę nad nimi.
Ak by ste chceli kópiu tohto dokumentu vo vašom jazyku, prosím skontaktujte nemocničné
pracovisko, alebo oddelenie zodpovedné za starostlivosť o vás.
Pokud byste měli zájem o kopii tohoto dokumentu ve svém jazyce, kontaktujte prosím oddělení
odpovídající za Vaši péči.
Чтобы получить копию этого документа на вашем родном языке, пожалуйста обратитесь в
отделение, ответственное за ваше лечение.
We have allocated parking spaces for disabled people, automatic doors, induction loops, and can
provide interpretation. For assistance, please contact a member of staff
This leaflet has been produced with and for patients
Information produced by the Physiotherapy Department
Date reviewed: May 2015
Next review date: May 2017
RK/EKH063