Rotator cuff tears

The total tearing of the tendon (shoulder capsule) from the upper arm bone is referred to as a ‘rotator cuff tear’. A rotator cuff tear usually occurs due to the weakening of the tendon in prolonged wedging against the roof of the scapula (wear-and-tear injury), but it can also occur suddenly due to a fall on the arm or pulling on the arm.

For athletes who heavily engage their upper arms, the rotator cuff can fail prematurely due to intensive use. These tears are usually on the inner side of the tendon.

Complaints for tendon tears:

• In the beginning stage, the patient finds it particularly difficult to do work above shoulder height (cleaning out gutters, hanging out the laundry). The pain is typically situated above the arm and under the shoulder joint.
• In a more advanced stage, there is also pain at night, and when lying on the shoulder.
• A complete tear of the rotator cuff causes severe loss of strength: you can only lift the arm with difficulty or move it backwards. Combing one’s hair, dressing and undressing and driving a vehicle all become difficult.
• In the end stage, when all tendons have been torn, the arm can barely be used anymore.

A tendon tear can often be diagnosed by pain and loss of strength during certain activities.

Other causes of pain and loss of strength in the upper arm, such as a hernia in the neck or a 'frozen shoulder' brought about by capsule stiffening, need to be ruled out.

It is important to note that there are surprisingly few complaints of pain and movement restriction in a number of patients, even though they have a significant tear.

Besides clinical studies, technical studies also support the diagnosis:

• Ultrasound: shows a tear in the tendon, tendon wear and fluid in the joint.
• CT or NMR scan, with contrast agent: this provides an accurate impression of the size and adhesiveness of the tendon. The quality of the involved muscles can also be evaluated with these tests.

If the tendon tears away from the attachment site at the bone, it can be re-attached. Other types of tears are those where relatively little tendon has detached from the bone, but where a hole has been created by the tearing of the tendon itself.

Sometimes, this is performed arthroscopically (keyhole surgery) , but in our hospitals, this is usually performed as a mini-open procedure.

The mini-open procedure involves making a four-to-five centimetre incision in the ball of the shoulder. The underlying muscle is split without causing damage, after which the diseased bursa needs to be removed in order to reach to the rotator cuff. The cracks are repaired at the edges before being attached to the bone, very often mounted on anchors fixed in the bone. Tendon tears are sutured. If there is a tendon tear in the area of the biceps, or if the biceps is worn, inflamed or torn, it will be removed at its attachment.

A keyhole surgery is done and bone plates or screws are used. This contains wires that allow us to reattach the severed tendon to the upper arm bone.

Latest publication date: 15/05/2024