Rotator Cuff Problems

The rotator cuff is a description of a group of tendons around the shoulder which are crucial to the normal functioning of the shoulder joint. Quite commonly they are responsible for pain in the shoulder which is characteristically perceived in the upper arm. Doctors describe the pain which comes from the rotator cuff as impingement.

There are a number of reasons why people suffer from impingement and commonly include overuse, injury, calcific deposits, age, inherited genes, rotator cuff tears, long head of biceps problems, and underlying laxity (excessive looseness of the shoulder joint).

The assessment of shoulder impingement usually includes listening to your history, performing a clinical examination, and obtaining a simple xray. Further imaging is often helpful. A simple ultrasound is often sufficient although occasionally an MRI will provide other useful information.

Treatment depends on the cause. But typically will be in offered in a step-wise sequence:

  • rest and activity modification
  • anti-inflammatory tablets and simple painkillers
  • physiotherapy
  • cortisone injection
  • surgery

You will probably have tried some of these before coming to see the specialist. Not all steps are appropriate in all cases.

If you happen to have a really bad rotator cuff tear then you may need encouraged to try to strengthen the anterior deltoid muscle in order to improve pain and movement. Download the exercise programme here.

Harry talks you through your clinic appointment for shoulder impingement.

Arthroscopic Subacromial Decompression
Including arthroscopic AC Joint excision, excision of calcific deposit, and long head of biceps tenotomy

This operation is sometimes offered to people who have impingement symptoms which are not getting better despite trying all other treatments. It is often combined with other procedures as described below.

It is a straightfoward and quick procedure performed under general anaesthetic as a daycase. It is safe and is often effective. However it is not a quick fix and most people find the first week or two to be quite uncomfortable. Thereafter things slowly improve and by 3 months you should be really good.

To date Harry has performed 2127 arthroscopic subacromial decompressions with a success rate of 87%.

For information regarding the operations of arthroscopic subacromial decompression, acromioclavicular joint excision, excision calcific deposit, and long head of biceps tenotomy click here.

Read the diaries of a young woman or an older man undergoing these operations.

Hot Topic

The role of the operation of arthroscopic subacromial decompression has been called into question by a recent publication from Oxford. There is an inference from the paper that this operation does not work but actually it only tells us that we don’t understand how or why it works!

Those patients who had the operation had a better outcome than those people who did not have the operation. I have many many satisfied customers which includes a number of shoulder surgeons themselves! I still believe that when offered in the right circumstances it is a safe and effective procedure. The response to this publication by the British Elbow and Shoulder Society can be found here.

Harry Brownlow discusses important information you should consider before undergoing subacromial decompression surgery.

The postoperative physiotherapy protocol can be found here

Calcific Tendonitis

Calcium deposits within the rotator cuff tendon are quite a common cause of shoulder impingement. Generally there are two forms.

  1. Acute calcific tendonitis – this is an agonising condition of the shoulder. It often starts very quickly overnight for no apparent reason. Pain is on a par with kidney stones, heart attacks and child birth! We dont know why it happens. The best treatment is rest, anti-inflammatory tablets and a cortisone injection. It usually settles down after about 10 days and rarely recurs. It has nothing to do with diet or calcium intake.
  2. Chronic calcific tendonitis – this is the more common variant. It is often associated with persistent impingement symptoms which don’t settle despite all the usual treatments. It is easily seen on x-ray or ultrasound. There are a number of treatment options ranging from waiting for natural resolution, needling, shockwave therapy, cortisone injections, or arthroscopic surgery.

Harry discusses this painful condition and the treatment options for calcific tendonitis of the shoulder.

Rotator Cuff Repair

The rotator cuff can tear for a number of reasons

  • age – the older you are the more likely you are to have a rotator cuff tear
  • genes – it has been shown that the genes you  inherit probably influence whether or not you have a tear
  • use – tears are more common on your dominant side
  • injury – there is often, but not always, a contributory injury to the tear

Imagine an old friendly pair of trousers. One day you bend down and they rip. That is because the material has become worn. This is the analogy for age and genetically related rotator cuff tears. Surgery in this case is absolutely a last resort and is not usually necessary. Many people have rotator cuff tears without even knowing about it. If they have happened gradually then the body has the ability to compensate with other tendons.

However, imagine you have put on a new pair of trousers but rip them when you fall off your bike. This is the analogy of a traumatic rotator cuff tear. In these circumstances surgery would be advocated to repair your good tendon because it cannot heal itself.

Many people have a slightly worn pair of trousers and then rip them by snagging a bramble. In these circumstances it is usually sensible to try to manage the painful symptoms with time, analgesia, a cortisone injection and some physiotherapy. If this strategy is unsuccessful then an operation may be considered.

Harry has performed 560 arthroscopic rotator cuff repairs with a success rate of 94%.

Information regarding the rotator cuff operation can be found here.

For the postoperative physiotherapy protocol click here.

To read the diary of a woman who underwent a rotator cuff repair click here.

Harry discusses when surgery is recommended and what to expect if you are having a rotator cuff repair.

 

Testimonials

“My shoulder feels wonderfully fixed again, thanks to Mr. Brownlow’s amazing skill”  – Rotator cuff repair

“I am now pain free for the first time in many months!” – Excision of calcific deposit

“I am delighted to have been referred to Mr Brownlow. Well done. – Shoulder impingement