Shoulder Pain & Rotator Cuff Surgery: Q&A with Mr Omar Haddo

Q: My shoulder hurts… what should I do?

It is important to establish if the pain is originating from the shoulder itself or if there is another cause, like the neck for example. Shoulder pain can be over the shoulder or can be felt in the upper arm. It rarely radiates beyond the elbow and it is often made worse by movement of the arm.

If the pain started after an injury, then you should certainly see a doctor. This is to rule out any fractures or injuries to the tendon or ligaments.  An X-ray or a scan may be required depending on the clinical assessment.

If the pain started spontaneously, then it is worth while waiting to see if it settles down first. You can help this with rest and simple analgesia (ensure there are no contra-indications).

Q: I injured my shoulder and have been to A&E. X-rays showed no fracture but it still hurts. What should I do?

If you are slowly improving and the movement in the shoulder is also improving then it is worth trying rest and analgesia as above.

If pain is worsening or if the movement is not improving after a couple of weeks, then you should seek advice from a medical specialist to ensure there is not any tendon injury.

Q: What is Impingement Syndrome?

This is a condition that causes pain on the outer aspect of the arm. It may also cause pain at night. The pain is often worse with lifting of the arm above shoulder level. There are several conditions that can cause this.

Q: I was told I have a ‘rotator cuff’ problem. What is that?

The rotator cuff is a group of tendons that move your arm/shoulder. They can become inflamed or torn. This can lead to pain in the shoulder presenting as impingement (see above).

Q: How do you treat rotator cuff problems?

The diagnosis will involve clinical assessment and a scan (MRI or ultrasound). In most cases these conditions can be treated without surgery. Usually the doctor would recommend pain killers first, together with rehabilitation and specific exercises. A good proportion of patients will achieve good pain relief and return to normal activities with these. If the above is unsuccessful, the doctor may them suggest a steroid injection. This has a slightly better success rate but carries the risk of infection, temporary poor blood sugar control in diabetics and skin discolouration. If all fails, then surgery may be an option in certain cases.

Q: What does rotator cuff surgery involve?

The surgery for rotator cuff varies from a subacromial decompression (shaving of a bony spur that may irritate the tendon) to a tendon repair. The surgery is usually performed arthroscopically (keyhole), which minimises recovery time (compared with open surgery). The choice for surgery is dependent on many factors (for example the size of the tear and how long the tendon has been torn for). As with any surgery, this has risks which include infection, bleeding, nerve injury, stiffness, failure of the repair and persistent pain.

The surgery can be done as a day case but may need a one night stay. It is usually carried out under general anaesthetic. Sometimes a nerve block (injection at the base of the neck) is given to help with the pain relief afterwards.

Q: How long is the recovery afterwards?

After the operation, you may have to wear a sling. This is dependent on the type of operation carried out and the size of the tendon that was repaired. This maybe as short as 2 weeks but can sometimes be as long as 6 weeks depending on individual patient needs.

Once the sling is removed, most cases will require physiotherapy to help regain the range of movement and the strength. The recovery can take up to 6-9 months.

As a rough guide, patients will return to driving 2 weeks after the sling is removed. Return to swimming will be around 4 months, gym and golf about 6 months and contact sport 6-9 months.

Mr Omar Haddo, Consultant Orthopaedic Upper Limb Surgeon at Highgate Private Hospital. His experience includes various aspects of orthopaedics including peripheral nerve repair, paediatric orthopaedics and bone tumour surgery. His Clinical Interests within Trauma and Orthopaedics are shoulder, elbow, hand and wrist surgery, as well as upper limb sports injuries.