Rotator cuff tear: Persistent pain, chronic insomnia, and the patient's journey to functional recovery in a middle-aged female

Rotator cuff tear is one of the most common causes of chronic shoulder pain in middle-aged and elderly individuals. Many cases have no clear history of trauma but develop on the background of chronic tendon degeneration.

Typical symptoms include:

• Persistent shoulder pain.
• Pain that worsens at night.
• Decreased muscle strength and limited shoulder range of motion.
• Difficulty performing movements of raising the arm overhead or behind the back.

A female patient came to Dr. Vu Anh with prolonged left shoulder pain. Initially, the pain was dull and did not significantly affect daily activities, leading the patient to believe it was just regular inflammation or aches due to aging.

However, over time, the pain progressively increased. Notably, the pain intensified at night, causing frequent insomnia. About a week prior to the visit, the symptoms became more severe, resulting in insomnia and requiring the patient to sit up and massage the shoulder area to relieve the pain.

At its worst, the shoulder range of motion was significantly reduced. The patient was unable to actively raise the arm above shoulder level, and daily living activities such as brushing hair, tying hair, dressing, washing the face, or brushing teeth all required the assistance of the contralateral hand. The motor function of the affected upper extremity was almost severely restricted.

The patient shared that she had previously sought medical attention, been diagnosed with tendinitis, and undergone conservative treatment with various methods including medical therapy, physical therapy, and injections. Although symptoms temporarily improved after treatment, the pain quickly recurred and continued to progress in severity.

Following a clinical examination combined with magnetic resonance imaging (MRI), the patient was diagnosed with a rotator cuff tear of the shoulder and indicated for shoulder arthroscopy to address the injury and restore motor function.

About 2 weeks postoperatively, the patient began to show marked improvement in motor function. She then continued to participate in an intensive physical therapy program for nearly 1 month. Thanks to good adherence to the treatment and exercise regimen, the shoulder function recovered favorably.

At the follow-up visit, the patient achieved an estimated recovery level of about 90%. Arm elevation was good, and the patient was able to perform overhead reaching, hair tying, and hair brushing. Shoulder abduction, flexion, and rotation movements were good. The patient no longer experienced severe night pain, and activities of daily living were virtually unrestricted.

Image 1: The patient at a follow-up visit with Dr. Vu Anh

The patient reported that movements previously considered almost impossible, such as getting dressed, personal hygiene, or brushing hair, can now be performed independently without the assistance of the contralateral hand.

Images 2-3: The patient demonstrates good arm elevation and normal range of motion

For me, every time I see a patient regain motor function and return to their daily lives with greater confidence, it is a tremendous joy. That is also the motivation for me to continue accompanying patients on their journey of treatment and functional recovery.