Understanding Rotator Cuff Tears: Signs, Causes, And Treatment Methods

Understanding Rotator Cuff Tear

Every week, the doctor performs several shoulder arthroscopy procedures for rotator cuff tears. The typical clinical scenario involves a female patient, aged around 50 to 65, presenting with prolonged shoulder joint pain, nocturnal shoulder pain, and limited shoulder range of motion.

In the past, these cases were commonly diagnosed as “periarthritis of the shoulder” and treated primarily with conservative management and physical therapy. However, failing to accurately diagnose whether there is a tendon tear leads to ineffective treatment and potentially worsening pain for the patient. Furthermore, delayed intervention for tendon tears creates difficulties in subsequent treatment, sometimes resulting in irreversible damage to the rotator cuff tendons.

Figure 1. Rotator cuff tear (primarily involving the supraspinatus tendon)

In clinical practice, rotator cuff tear is one of the most common shoulder joint injuries. It can occur at any age, with or without trauma, causing patients pain, restricted shoulder mobility, weakness in the periarticular muscle tone, and significantly impacting the patient's daily activities.

In elderly women, rotator cuff tears typically occur due to the natural aging and degeneration of the tendons. The condition not only causes dull pain, especially at night, but also restricts arm mobility and significantly affects the patient's daily life, working capacity, and sleep quality.

Causes and signs of rotator cuff tears

Due to age-related tendon degeneration, tendons lose their inherent elasticity and resilience, making daily activities or minor injuries sufficient to cause a tear.

Signs and symptoms include:

- A dull ache deep within the shoulder joint.

- Increased pain when lying on the affected side, disrupting sleep.

- Muscle weakness, difficulty performing movements such as combing hair, dressing, or reaching for objects overhead.

How is a rotator cuff tear treated?

Treatment for a rotator cuff tear must follow a protocol, typically starting with physical therapy and potentially involving surgical intervention if necessary. Nowadays, with the advent of arthroscopic surgery, tendon repair has become much easier and the surgical scars are far more cosmetic.

In 2019, during my residency in France, I regularly assisted the professor there with shoulder arthroscopies, usually on Tuesdays and Wednesdays. The surgery was performed in the "ambulatoire" (ambulatory surgery unit). Patients would arrive in the morning for surgery and could be discharged in the afternoon.

In Vietnam currently, this practice is not yet feasible. Typically, patients require about 2 to 3 days of hospitalization for postoperative pain management. From 2020 to the present, I have performed surgery for over 2,000 cases of arthroscopic rotator cuff repair with excellent recovery outcomes. Videos are available on my TikTok channel for those who wish to learn more.

Figure 2. Arthroscopic view of a rotator cuff tear

Figure 3. Tendon sutures (rotator cuff surgeons always seem to have a fondness for intricate suture patterns, and I am no exception)

Figure 4. The rotator cuff tendon has been reattached to the humeral head

Figure 5. Another case repaired with 8 ultra-high-strength sutures and a "bridge" technique