Shoulder Pain – Do You Have a Rotator Cuff Tear?


Pain in the Shoulder

A common cause of shoulder pain in a person above the age of 50 is a tear in the rotator cuff.

The rotator cuff is a group of 4 tendons that envelopes the shoulder joint and help to move the shoulder.  The tendons are called supraspinatus, infraspinatus, teres minor and subscapularis.

Rotator cuff anatomy

Rotator cuff

Rotator cuff tendons can tear after trauma e.g. shoulder dislocation in an adult above 45 years old, a fall on an outstretched hand, or it can tear due to degenerative changes associated with aging or with bone spurs of the acromion (part of the shoulder blade that lies above the shoulder joint).

The commonest tendon to tear is the supraspinatus tendon which lies on the superior aspect of the shoulder joint. Such tears usually start off as a small rent and with the constant pull of the muscle belly, the tendon tear gradually enlarges and retracts away from the bone where it was supposed to be attached.

The symptoms of a rotator cuff tear includes pain in the shoulder and deltoid muscle region with movements of the arm above the level of the shoulder.  Many of my patients experience pain at night and they cannot sleep on the side of the shoulder with the tendon tear. When the tendon tear becomes massive, the patient may even have difficulties lifting the arm upwards.  Some patients may even mistake their problem to be from a stroke.

The diagnosis can be confirmed with an ultrasound scan or MRI scan.

MRI Showing Supraspinatus Tendon Tear

MRI showing a Tear in the Supraspinatus Tendon

Full thickness rotator cuff tendon tear do not heal.  The treatment is usually surgical.

Surgery is via minimally invasive keyhole approach.  A tiny camera is introduced into the shoulder joint to visualise the tendon tear.  Tiny portal holes are created around the shoulder joint to allow us to treat the tendon tear.

The first stage of the procedure usually involved removal of the overlying bone spurs in the anteroinferior edge of the acromion bone.

Subacromial Decompression

Subacromial Spur | Removal of Spur

Next the tendon tears are reattached to the humeral head tendon footprint using absorbable suture anchors.

Supraspinatus Tendon Tear

Cuff Tear

Suture Anchor Insertion

Suture Anchor

Suture Passage

Stitching the Torn Tendon

A Successful Cuff Repair

Repaired Rotator Cuff Tendon

The surgery usually lasts 2 to 3 hours.

For appointment, call 68366636 or email hcchang@ortho.com.sg.

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