Common Rugby injuries: Rotator Cuff tear

There were injuries galore in the rugby news last week, and what better opportunity to introduce a new series of articles by leading consultant orthopaedic surgeon Simon Moyes on how to identify and treat common rugby injuries.

Simon MoyesThe first up is one that can happen very easily and causes players a lot of discomfort and time on the treatment table – the rotator cuff tear.

The rotator cuff is a group of muscles and tendons that attach the arm to the shoulder joint, which help us to lift our arms up over our heads and rotate them towards and away from our bodies. The tendons also help to stabilise the ball and socket joint of the shoulder.

It is one of the muscle areas of the body frequently injured by tears, tendonitis, impingement, bursitis and strains. Initially injuries may only be fairly minor, but can get progressively worse through repetitive use or re-injury.

If you have suffered such an injury, you will typically experience acute pain when the tear happens in addition to a snapping sensation and immediate and prolonged weakness in your arm. You are also likely to feel a sharp pain in the front portion of your shoulder, which radiates down the side of your arm. Furthermore, you may feel pain when sleeping on the affected side, or when reaching or lifting above your head.

Rotator cuff problems are usually broken up into three categories:

Rotator cuff tendonitis:
Also referred to as impingement syndrome or shoulder bursitis, usually affects people aged 30-80 years of age. This weakness in the shoulder is usually mild to moderate.

Rotator cuff tear:
Affects people who have suffered with tendonitis for some time in addition to those who are beginning to experience heightened weakness in the shoulder. It can also develop if you attempt to lift objects which are too heavy. In this case, patients will experience a pop in their shoulder.

Instability impingement:
Typically affects younger patients aged 15-30 years old. The rotator cuff can become irritated if the shoulder is loose in the socket. This often happens after the patient participates in repeated fast movements such as throwing a ball.

During diagnosis, surgeons will conduct an initial x-ray of the affected shoulder to highlight the narrowing space between the cuff and the bone. This will usually be followed by an MRI scan to confirm the diagnosis, because it shows both complete and partial tears in the cuff. Ultra-sound may also be used as an alternative form of treatment for detecting rotator cuff tears.

Initially painkillers or anti-inflammatory medications will be used to lessen the pain and inflammation of the affected area. Physiotherapy can keep the shoulder strong and flexible while cortisone injections can be used to reduce inflammation and control the pain.

In some cases, surgery will be necessary and involve the surgeon making small incisions and repairing the rotator cuff with minimal damage to the surrounding tissues. In order to carry out the procedure, the surgeon will look through a small camera and watch his repair on a television monitor. This is known as arthroscopy and leaves the patient with minimal scars and a fast recovery period.

If you have a question about arthroscopy or keyhole surgery please leave a comment in the box below or email simonmoyes@simonmoyes.com, call 0207 323 0040 or visit www.simonmoyes.com or www.shoulder-arthroscopy.co.uk.