Written by Dr Gowreeson Thevendran, MBChB (Bristol), MRCS.Ed, Dip. Sports Med.Ed, FRCS.Ed (Trauma & Ortho. ), FAMS (Singapore)
Table of Contents
What Is The Rotator Cuff
The rotator cuff, comprising a critical ensemble of muscles and tendons, plays a pivotal role in the anatomy of the shoulder joint. Functionally, the rotator cuff facilitates a wide range of shoulder movements, from lifting and rotating the arm to performing intricate tasks. It ensures the upper arm bone’s stability within the shoulder’s socket, preventing dislocation and maintaining joint integrity during motion.
Beyond movement, the rotator cuff also plays a vital role in safeguarding the shoulder joint from injury, absorbing shocks, and distributing stress evenly across the joint.
Injuries to the rotator cuff are common and can vary in severity. They may often present as a persistent, dull ache in the shoulder area with a discomfort that notably worsens during the night. Individuals experiencing shoulder discomfort or suspect a rotator cuff injury are advised to consult a healthcare professional promptly for diagnosis, intervention and treatment in Singapore.
Types Of Rotator Cuff Injuries
A rotator cuff injury is a common concern affecting shoulder health, and can manifest due to a variety of factors, each with its own implications for mobility and pain management. The condition can range from:
General Wear and Tear
Over time, the rotator cuff is subjected to daily stresses that can gradually erode the tendons. This degradation is a natural consequence of ageing and repeated use, leading to stiffness, discomfort, and a diminished range of motion in the shoulder.
Tendonitis
Tendonitis is characterised by the inflammation of the rotator cuff tendons, often resulting from overuse or repetitive strain. Symptoms include pain, especially with overhead activities, and a general feeling of tenderness around the shoulder joint.
Bursitis
Similar to tendonitis, bursitis involves inflammation, but of the bursae—small fluid-filled sacs that cushion the shoulder joint. This inflammation can cause swelling, pain, and restricted movement, often exacerbating the discomfort caused by other rotator cuff conditions.
Tendon Strain or Tear
Tendon strains are minor injuries to the tendon fibres that can cause pain and limited function. More severe are tendon tears, which can be partial (the tendon is still attached to the bone) or complete (the tendon is entirely detached). These injuries can significantly impact shoulder strength and mobility, often requiring more intensive treatment or surgery.
Shoulder impingement
Shoulder impingement occurs when the space between the shoulder blade and the rotator cuff narrows, pinching the tendons. Repetitive overhead motion or anatomical predispositions can lead to impingement, causing pain and limiting the shoulder's range of motion.
Mild cases such as tendinitis may cause discomfort but often improve with rest and anti-inflammatory treatments, while partial tears can significantly impact shoulder strength and mobility, leading to pain during arm lifting and at rest. Early and accurate diagnosis, possibly followed by a rotator cuff surgery for more serious tears, is crucial for recovery.
Symptoms Of A Torn Rotator Cuff
Symptoms of a torn rotator cuff include:
- Persistent shoulder pain, especially at night or when lifting and lowering the arm
- Weakness in the shoulder when performing certain movements
- A crackling sensation (crepitus) when moving the shoulder in certain ways
- Limited range of motion and difficulty with activities like combing hair or reaching behind the back
Diagnosing Rotator Cuff Tears
Diagnosis involves a combination of:
- Physical examination to assess pain, range of motion, and muscle strength
- Imaging tests like X-rays can rule out other causes of shoulder pain
- MRIs and ultrasounds provide detailed images of the rotator cuff to confirm the presence of a tear
Non-surgical Rotator Cuff Tear Treatment
Non-surgical treatment options for rotator cuff injuries may include:
- Physiotherapy
Physiotherapy programs play a crucial role in the rehabilitation of rotator cuff injuries. Through targeted exercises, patients can strengthen the shoulder muscles, improve flexibility, and increase the range of motion. Physiotherapy not only aids in the recovery process but also helps in preventing future injuries. - Anti-inflammatory Oral Medications
Anti-inflammatory oral medications are used to reduce inflammation within the shoulder joint, thereby decreasing pain and improving mobility. Managing pain and inflammation can significantly enhance the quality of life temporarily for individuals with rotator cuff injuries.
Rotator Cuff Surgery
Rotator cuff surgery becomes crucial when severe tendon tears occur or when conservative measures such as physical therapy and medications fail to alleviate the pain and discomfort.
Arthroscopic Tendon Repair
Arthroscopic tendon repair is a minimally invasive procedure that employs an arthroscope to mend the torn rotator cuff tendon. By making small incisions, surgeons can insert the arthroscope and specialised instruments to reattach the torn tendon back to the bone, causing minimal harm to the surrounding tissues. This approach significantly reduces recovery time and post-surgery discomfort, making it a preferred method for many patients and surgeons.
Open Tendon Repair
Open tendon repair is usually recommended for more complicated cases where the rotator cuff tear is large or complex. This procedure offers the surgeon an unobstructed view of the rotator cuff, facilitating a thorough tendon repair. Though it involves a larger incision and a longer recovery period compared to an arthroscopic surgery, it allows for the comprehensive correction of extensive tendon damage.
Mini-Open Rotator Cuff Repair Surgery
The mini-open rotator cuff repair surgery merges the benefits of both arthroscopic and open surgery techniques. It begins with an arthroscopic examination to evaluate and address joint damage, followed by a minor open surgery to repair the rotator cuff directly. This method of surgery limits the size of the incision and reduces tissue disturbance while providing the surgeon with direct access to the tendon for a precise repair.
Tendon transfer
In situations where the rotator cuff tear injury cannot be repaired directly, a tendon transfer may be advised for the patient. This innovative procedure repurposes a nearby tendon to take over the functions of the damaged rotator cuff tendon, thereby restoring shoulder strength and mobility. Tendon transfer is particularly useful for patients with irreparable rotator cuff injuries.
Shoulder replacement
For patients with severe rotator cuff damage compounded by arthritis, a shoulder replacement surgery may offer comprehensive relief. A shoulder replacement surgery is a medical procedure designed to address chronic shoulder pain and restore functionality. This operation involves the removal of damaged areas within the shoulder joint and their subsequent replacement with artificial components, known as prostheses. These prosthetic parts are engineered to mimic the natural movement of the shoulder, offering patients a chance at a pain-free existence and significantly improved joint performance.
Recovery Period For Rotator Cuff Surgery
The journey to recovery after the rotator cuff surgery varies based on the specific surgical procedure and the patient's overall health. Patients will be advised to rest in order to foster healing of surgical incisions and the reattached tendons.
The duration of complete recovery spans several months, contingent upon diligent adherence to rehabilitation exercises and the body's natural healing pace. Throughout this period, patients will receive continuous supervision and monitoring from their doctor and medical team in Singapore, providing guidance to navigate the recovery process effectively and optimise the surgical outcomes of a rotator cuff surgery.
Dr Gowreeson Thevendran
Dr Gowreeson Thevendran is an orthopaedic surgeon in Singapore that specialises in orthopaedics and trauma surgery, including rotator cuff surgery. His particular skill set is minimally invasive surgical techniques to treat foot, ankle, knee, and hip/thigh conditions. He pursued fellowship training for sports surgery at Chelsea & Westminster Hospital, UK and complex trauma and deformity correction at Royal Liverpool University Hospital, UK. He also continues to serve the Orthopaedic Department at Tan Tock Seng Hospital as a visiting consultant.
If you are suffering from pain or injuries in any other joints such as hips or shoulders, you can consult our qualified orthopaedic surgeon who will thoroughly assess your condition.
Furthermore, our orthopaedic surgeon in Singapore can also assist you with other painful conditions related to your foot or ankle through appropriate procedures which may include bunion surgery, treatment for plantar fasciitis and other surgeries.
Qualifications
- Bachelor of Medicine and Surgery, University of Bristol, England
- Fellow of the Royal College of Surgeons, Edinburgh
- Diplomate Faculty of Sports and Exercise Medicine, Royal College of Surgeons Edinburgh
- Fellow of the Academy of Medicine, Singapore
Awards
- SICOT PIONEER Founders Award 2020
- 2015 European Foot & Ankle Society ‘Best Podium Presentation’ Award
- 2013 Singapore Orthopaedic Association Junior Travelling Fellowship
- 2012 NHG Critical Talent Special Recognition Award
- 1998 Enid Lindt Prize in Clinical Surgery
- 1995 Public Services Department Full Medical scholarship
Rotator Cuff Surgery Frequently Asked Questions
Causes of rotator cuff injuries can originate from a range of activities and conditions. Repetitive motions above the head, the natural wear associated with ageing, sudden injuries, and progressive weakening of the tendons all contribute to the risk of a rotator cuff injury. Understanding these causes is vital for prevention and early intervention. If you are residing in Singapore, you can consult our orthopaedic specialist at Orthofoot MD.
Orthofoot MD is on the panels of different health insurance plans and also accepts Medisave. Patients seeking rotator cuff surgery in Singapore should inquire with both their insurance provider and the clinic regarding their eligibility for insurance and Medisave coverage. While multiple treatments may be covered, the extent of coverage for rotator cuff surgery may vary and is subject to verification by the clinic.
Rotator cuff surgery is typically a safe procedure. However, as with any surgery, it carries some risks. These may include the possibility of infection, nerve damage, not achieving complete symptom relief, or experiencing a re-tear of the tendon. Discussing these risks with your healthcare provider in Singapore is essential to make an informed decision about the surgery.
Rehabilitation following rotator cuff surgery is fundamental for a successful recovery. It aids in regaining muscle strength, enhancing flexibility, and restoring the full range of motion. In Singapore, a dedicated rehabilitation program is key to ensuring a return to daily activities and maintaining shoulder health post-surgery.
Clinic Location
OrthofootMD@Novena
- Mount Elizabeth Novena
38 Irrawaddy Road #05-42 Mount Elizabeth Novena Specialist Centre Singapore 329563
OrthofootMD@Mount Alvernia Hospital
- (Mount Alvernia Hospital)
820 Thomson Road #01-01/02 Mount Alvernia Medical Centre A Singapore 574623