Rotator cuff is formed by confluence tendons of a group of four muscles around the shoulder. These muscles are not so strong, but have a pivotal role of keeping the shoulder ball centered over the cup, while the other stronger muscles can be effectively used to lift the shoulder. If these muscles are torn, this synchronized function of the shoulder is affected. In extreme cases, one finds it impossible to life the shoulder at all.
The usual story is a rather minor fall leading to pain in the shoulder. Considering it a minor injury, the patient tries to live with it. X-rays are normal as the torn cuff can not be seen on x-rays. One often tries a course of physiotherapy before finally seeing a specialist. It is possible to diagnose the tear on clinical examination, but confirmation is by MRI.
Minor tears may heal up with time, or may become symptomless over a period of time. Tears of moderate size may continue to produce pain and weakness. One finds it difficult to sleep, and bring the hand forward to pick up things from a distance. By testing certain movements, it is possible to diagnose which of the four tendons are torn.
Tear of just one tendon in a low-activity elderly person may be compatible with normal life at that age, but more than one tendon always need to be fixed surgically. If not fixed, there is a tendency for the tear to increase in size, and the concerned muscles to lose their bulk and strength. The repair used to be done by open surgery in the past, but is now done with arthroscopic surgery.
Arthroscopic surgery for cuff repair involves general anaesthesia. Four to five small cuts (<1 cm each) are made on the shoulder. A thin telescope is introduced inside the shoulder, and the inside can be seen on TV screen. The shoulder is thoroughly examined and the extent of tears judged. Fine instruments are introduced through other key holes, and the cuff tear is repaired. For re-fixing the tear to the bone, special device called anchors are used. The shoulder is rested in a sling for a period of 4-6 weeks, after which physiotherapy is begun. It takes anywhere from 3-6 months to recover.Post-surgery physiotherapy is as critical to recovery as the operation itself.