Shoulder

Symptomatology :Pain On Reaching


Rotator Cuff Tear

This is probably the most common condition seen in my practice and is known as rotator cuff impingement/tendinopathy. The rotator cuff tendons help to elevate and rotate the shoulder from the waist. Pain on reaching and weakness can involve tears within the tendons. It also includes pain arising from the AC (acromioclavicular) joint. The pain can be felt at the top of the arm just above the elbow and is worse on reaching around to the back, difficulty sleeping and reaching up. Common investigations for this condition are simple plain x-ray, ultrasound or MRI scan of the shoulder.
Treatment can include physiotherapy including acupuncture and massage, steroid injections carried out in an out-patient setting or arthroscopic / keyhole surgery. Arthroscopic surgery is generally safe and reliable and has around an 85 to 90% success rate. Arthroscopic surgery is performed through three holes into the shoulder, one at the front, one at the side and one at the back. The surgery involves removing any inflamed tissue, debridement of the tendons and shaving off some of the acromion bone (hooked bone) and its leading edge in order to open up the space for the tendons to move around more easily. If your imaging and assessment shows pain coming from the AC joint which could be arthritic, then a few millimetres of your end of your collar bone (clavicle) may be removed as well. Surgery is usually carried out as a day case so you are able to go home the same day. It is commonly done under a general anaesthetic with a regional block (injection into the nerves in the neck which will anaesthetise the arm so when you wake from surgery although the arm will feel numb and weak it should feel very comfortable).
The risks involved with arthroscopic surgery are infection, bleeding, nerve injury, pain and stiffness. Average recovery is anywhere between six weeks up to three to four months.
With AC joint excision recovery can be longer and it can take up to six months for symptoms to completely settle down.
If at the time of surgery your tendons require repair, then recovery is much more prolonged. Pre-operatively I will assess the size of the tear and the state of the tissues depending on your imaging. Repair is again carried out arthroscopically which may mean an extra hole on the side of the shoulder. Repair is generally carried out with bone anchors (similar to a small wall plug). Some anchors are all now suture material. Sutures are passed with arthroscopic instruments through the tendons and secured down with knots in order to reattach the tendon to the bone. Surgery takes about one to two hours but this does depend on the size of the tear and, as already stated, recovery can be more protracted. With repair the shoulder may need to be protected for up to four to six weeks in a sling with a large tear and physiotherapy will be required for three months post operatively. The same surgical risks apply as for the decompression but there will be to a certain extent a larger degree of stiffness and slightly longer recovery. Surgery can still be performed as a day case. There is a risk of re-rupture although patients can benefit from significant pain relief even with re-rupture following arthroscopic surgery.

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