Information for patients from the Physiotherapy Department

Transcription

1 Rotator cuff tears Information for patients from the Physiotherapy Department If you have been diagnosed with a rotator cuff tear this leaflet will explain what a rotator cuff tear is, the associated signs and symptoms, and how it can be diagnosed. Although the exact method of treatment will differ from patient to patient, the most common treatment techniques and their likely outcome are also covered. What is a rotator cuff tear? Rotator cuff tears are among the most common causes of shoulder pain and disability. The rotator cuff is made up of four muscles and their tendons, which connect the shoulder blade to the humerus (upper arm bone) forming the shoulder joint. One of the key roles of these muscles is to stabilise or hold the shoulder joint in place when we use our arms. The strength of these tendons allows the humerus to be lifted and rotated. Front view Rear view The shoulder joint is a very mobile joint to allow it to be used for a wide range of movements. As such, the stability of this joint is compromised requiring the rotator cuff muscles to work hard. As we age it is normal for the rotator cuff tendon to wear and helps to explain why rotator cuff tears (partial or complete) are more common later in life (over the age of 40 years). 1

2 What are the signs/symptoms? Pain is usually experienced in the shoulder area. A catching sensation may be felt when you move your arm in particular directions. Difficulty sleeping on the affected side, due to pain. Weakness in the affected shoulder, although this depends on the size of the tear. Usually a complete tear is very obvious, since when your arm is raised above your head you will not be able to smoothly lower it to your side. Generally, the larger the tear, the more weakness it causes. Sometimes popping/clicking can be felt over the shoulder. Sometimes neck pain can accompany shoulder pain. Despite the fact that some people experience painful symptoms with rotator cuff tears, many people will have a tear with no symptoms or disability. A rotator cuff tear is often associated with previous shoulder problems, although occasionally individuals who have never had any previous shoulder problems may develop a tear due to a fall or injury. How will a rotator cuff tear be diagnosed? A physical assessment by a doctor or physiotherapist is helpful in diagnosing a rotator cuff tear. This will involve looking at particular movements of your shoulder and assessing it for any pain/ weakness. Additionally your health professional may request one of the following to confirm their diagnosis. X-ray - although x-rays will not show tears in the rotator cuff, other findings associated with rotator cuff tears may be evident. Ultrasound scan uses high frequency sound waves, which cannot be heard by the human ear, to create a computer image. An ultrasound scan is a useful way to examine the muscles, l ligaments, soft tissues, and joints of the body. MRI (magnetic resonance imaging) scan uses magnetic waves to create pictures of the shoulder in slices. The MRI shows soft tissues (muscles, tendons, ligaments) as well as bones and is a painless procedure not involving needles/injections. 2

3 What are the treatment options available? Medication The doctor may prescribe painkillers or anti-inflammatory medications to help ease the pain. It is important that you consult your doctor regarding the appropriate type of medication. Injections Some individuals find a corticosteroid injection helpful to ease the pain and swelling. The needle is put in to the space under the acromion (the front edge of the shoulder blade), not the tendon, and a mixture of local anaesthetic and corticosteroid is injected into the space. You may notice less pain to start with due to the local anaesthetic, but then the shoulder may be more painful until the corticosteroid starts working. With rotator cuff tears, sometimes the effects of corticosteroids do not tend to last very long and therefore they are not used regularly. When used, most doctors will not give more than three injections a year and if the symptoms do not settle down then other treatments may be recommended. Physiotherapy Physiotherapy usually consists of an assessment of your shoulder, followed by advice and additional treatments to control pain and inflammation, such as heat or ice. You will be advised to avoid positions that cause pain and to try to balance activity and rest of the affected shoulder. Hands-on treatments and various exercises are used to increase the shoulder joint movement and prevent it from stiffening up. Exercises also aim to improve the strength and control of the rotator cuff and shoulder blade muscles. Some physiotherapy departments may also offer complementary treatments such as acupuncture to help ease the pain. Occupational therapy Occupational therapy contributes to the rehabilitation of rotator cuff tears by providing help with personal tasks (such as washing and dressing) and everyday activities (like kitchen tasks). Therapy may involve teaching techniques which help these tasks or by providing a number of simple aids which can greatly improve quality of life. Examples include the helping hand, jar grippers, or aids to help you get dressed. Surgical management If your rotator cuff injury does not respond to these treatments after six to12 months you may be offered surgery. A procedure known as a mini-open repair is normally used. This involves an arthroscope (like a mini-telescope) being inserted to visualise the tear, assess and treat damage to other structures within the joint. Once this part of the procedure is complete the surgeon performs a mini incision (three to five centimetres) to repair the torn rotator cuff. You will still require physiotherapy following surgery. To start with, this will depend on how quickly the rotator cuff heals, which will take approximately six weeks. You will need to wear a sling during this time (four to six weeks) to allow the rotator cuff to heal. Exercises at this stage are limited, after which they can be increased appropriately; guided by your physiotherapist. Your consultant or physiotherapist will discuss the options available to you before any treatment begins. This will be a time for you to ask questions and/or express any concerns you may have about your condition. 3

4 How can I help myself? In the acute (early) stage a bag of frozen peas wrapped in a damp tea towel placed over the shoulder for 10 minutes at a time may help to reduce the inflammation and pain. Do not use these peas for eating once defrosted. You may find it more comfortable to lift your arm away from your side with your palm up rather than with your palm down, or you may find it helpful when lifting or lowering your arm to support your affected arm with your unaffected arm. Try to avoid repetitive overhead activities until the pain settles. Try to improve your posture; hold your back straight and your shoulders back. If your symptoms are aggravated by a sport you may benefit from advice from a coach/ instructor regarding your techniques. Do not let your shoulder stiffen; make sure that twice a day you move your arm through the full available range, or as pain allows. You can do this by lying on your back and lifting your arm above your head using the unaffected arm. Source: Please consult your GP for appropriate pain management advice. The outlook is good! Many patients with rotator cuff tears manage well with non-surgical treatment, in about six to eight weeks. Recent evidence shows exercise therapy has a better outcome in management of rotator cuff tears. Where surgery is considered necessary, there are similar success rates. However, rehabilitation can be a slow process and you should expect full recovery to take up to six to 12 months. As recovery and rehabilitation is such an individual process, returning to work or normal everyday activities should be discussed with your doctor/physiotherapist who will help decide what is appropriate for you. Further information If you have any comments please contact one of the following physiotherapy departments. William Harvey Hospital, Ashford Telephone: Kent and Canterbury Hospital, Canterbury Telephone: Queen Elizabeth the Queen Mother Hospital, Margate Telephone: For further information please go to 4

5 Any complaints, comments, concerns, or compliments If you have other concerns please talk to your doctor or nurse. Alternatively please contact our Patient Advice and Liaison Service (PALS) on or , or Further patient information leaflets In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets covering conditions, services, and clinical procedures carried out by the Trust. For a full listing please go to or contact a member of staff. After reading this information, do you have any further questions or comments? If so, please list them and bring to the attention of your physiotherapist or consultant. Would you like the information in this leaflet in another format or language? We value equality of access to our information and services and are therefore happy to provide the information in this leaflet in Braille, large print, or audio - upon request. If you would like a copy of this document in your language, please contact the ward or department responsible for your care. Pacjenci chcący uzyskać kopię tego dokumentu w swoim języku ojczystym powinni skontaktować się z oddziałem lub działem odpowiedzialnym za opiekę nad nimi. Ak by ste chceli kópiu tohto dokumentu vo vašom jazyku, prosím skontaktujte nemocničné pracovisko, alebo oddelenie zodpovedné za starostlivosť o vás. Pokud byste měli zájem o kopii tohoto dokumentu ve svém jazyce, kontaktujte prosím oddělení odpovídající za Vaši péči. Чтобы получить копию этого документа на вашем родном языке, пожалуйста обратитесь в отделение, ответственное за ваше лечение. We have allocated parking spaces for disabled people, automatic doors, induction loops, and can provide interpretation. For assistance, please contact a member of staff This leaflet has been produced with and for patients Information produced by the Physiotherapy Department Date reviewed: May 2017 Next review date: September 2019 RK/EKH063 5