Simple impingement (see link) tends to occur in the younger age group. As we age and arthritis of the shoulder becomes common, it is more likely that a tear in (one of) the (four) muscle tendons that make up the rotator cuff will be found at ultrasound.

Signs and Symptoms
It is possible to experience no symptoms at all from a rotator cuff tear and studies suggest that many of us these tears without any knowledge of them. However, if you experience pain when your arm is raised above the horizontal, it is possible that a tear in the rotator cuff tear has occurred together with impingement of the tendons. Weakness of the shoulder often occurs in addition to pain, particularly when bringing the arm back down towards the body – you may find your arm seems to drop down.

Diagnosis
You will be asked to explain your symptoms in detail before Mr. Sameer Singh will carefully examines your shoulder. An X-ray will be taken to see if you have arthritis or any other condition within your shoulder. We offer a One-Stop Ultrasound Clinic so at the same appointment Mr. Singh will also perform an ultrasound scan of your shoulder to examine the tendons in motion. (In many cases these examinations provide an accurate diagnosis, but if you have very severe symptoms and a significant a tear of the rotator cuff is, an MRI scan of your shoulder will be arranged.)

Initial Treatment
As with impingement, the treatment recommended depends on your symptoms together with the significance of any rotator cuff tear. With mild tears and minor symptoms, long-term relief can be achieved through anti-inflammatory medications and avoidance of aggravating activities. However, an injection of local anaesthetic and steroid into the shoulder may be necessary to settle the acute episode. As the inflammation subsides, physiotherapy exercises are encouraged to help strengthen the shoulder.

Further Treatment
If your symptoms persist or you have a significant rotator cuff tear, surgery may be recommended. The procedure used depends on the size, shape and location of the tear, but we always try and perform surgery using keyhole / arthroscopic techniques

There are three common surgical approaches to the shoulder:
• Arthroscopic Repair – this keyhole approach is technically demanding but is associated with a low complication rate and quick recovery
• Mini-Open Repair – a combination of open and arthroscopic techniques are used
• Open Surgical Repair – for large and complex tears, a traditional open type operation may be necessary

Mr. Singh is experienced in all shoulder procedures and will discuss them (each) in further detail at your appointment.