What is a Rotator Cuff Tear?

To get a better understanding of what a rotator cuff tear is, it would help to understand the anatomy of your shoulder. Your shoulder is made up of three bones. These are your humerus (the upper arm bone), your scapula (the shoulder blade), and your clavicle (the collarbone). The top of your humerus fits into the scapula to form your shoulder. 

Made up of four muscles that come together as tendons, the rotator cuff is what holds your scapula and humerus together. The rotator cuff is responsible for your ability to lift and rotate your arm.

If any of these tendons are damaged or torn, they are no longer fully attached to the top of your humerus. A torn tendon typically begins to fray before tearing completely. This may result in  either a partial or full-thickness tear. 

A partial tear refers to a damaged tendon that has not completely detached. Alternatively, a full-thickness tear refers to a complete tear that leaves a hole in the tendon. 

What Causes a Rotator Cuff Tear? 

A rotator cuff tear is typically caused by one of two things – these are either degeneration or injury. 

A degenerative tear refers to general wear and tear of the tendons that make up your rotator cuff over time. Factors such as repetitive stress injuries, a reduced blood supply (which occurs with age), and bone overgrowth (bone spurs) may all contribute to a degenerative rotator cuff tear. 

Alternatively, one may suffer from an acute tear which is the result of an injury. This can occur if you fall with an outstretched arm or try to lift a heavy object incorrectly. An acute tear can also happen together with other shoulder-related conditions such as a dislocated shoulder. 

What are the Symptoms of a Rotator Cuff Tear? 

The symptoms of a rotator cuff tear tend to occur both when trying to move the arm and when the arm is at rest. Patients often describe this as a weakness and ache in the arm, which can lead to issues trying to sleep at night. 

You may experience some of these symptoms if you are suffering from a rotator cuff tear: 

  • A dull ache from ‘deep’ in the shoulder 
  • Difficulty reaching back or overhead
  • Issues sleeping on the affected shoulder
  • A crackling sensation when the shoulder is moved in a particular direction

Rotator Cuff Tear Treatment

If you find yourself experiencing chronic shoulder pain, make an appointment to see a doctor. Treatment of rotator cuff tears varies based on several factors. Our doctors will first determine the type of tear you are suffering from. Additionally, they will also take into consideration your age, activity level, and general health before deciding on the best course of treatment. 

Non-Surgical 

Typically, a non-surgical treatment plan will be explored first. You may be asked to allow your shoulder plenty of rest by avoiding overhead activities and keeping the affected arm in a sling. You may also be prescribed anti-inflammatory drugs to reduce the swelling and pain. There are also some strengthening exercises that you may be asked to practice that can help relieve pain and prevent further injury. Lastly, our doctors may also prescribe a steroid injection. 

Surgical 

However, in certain high-risk individuals or if the symptoms persist, a surgical treatment plan may need to be put into place as there will be the risk of the tear increasing in size over time.

Surgery may be beneficial if you lead a reasonably active lifestyle and use your arms for overhead work or sports. Additionally, should your rotator cuff tear be causing problems with your daily activities such as dressing, washing and/or sleeping, our doctor may also advise that you explore the surgical treatment option. 

Typically, surgery to repair a rotator cuff tear involves reattaching the tendon to the humerus. However, our doctors will discuss which method best suits you and your needs.

What is Shoulder Impingement?

Shoulder impingement is usually caused by pinching of the rotator cuff tendons and their overlying bursa between the bones in one’s shoulder, which can occur when reaching overhead. Shoulder impingement can also be associated with other rotator cuff injuries. 

Typically, an impinging shoulder will resolve itself in a matter of weeks to months. This is especially so with the right strengthening exercises. However, there are cases where it can become an ongoing problem. 

What Causes Shoulder Impingement? 

The movement of lifting your arm causes the tendon to pass through the subacromial space, which exists at the top of your shoulder. This space can be narrowed with poor shoulder posture or poor muscle balance. 

Alternatively, the bursa overlying the tendons may become inflamed and irritated from either overuse of the shoulder or a shoulder injury. 

Other causes of shoulder impingement include the development of bony spurs on the acromion as one ages or a curved acromion.

What are the Symptoms of Shoulder Impingement? 

The symptoms of shoulder impingement are similar to that experienced if one is suffering from a rotator cuff tear. Your arm may hurt both at rest and when in motion. Patients often describe pain from a shoulder impingement as being a dull ache or weakness in the arm. 

You may experience these symptoms if you are suffering from a shoulder impingement: 

  • Pain from the side of the arm to the front of the shoulder
  • Stiffness 
  • Sudden pain when reaching upwards
  • Pain when resting

Shoulder Impingement Treatment

When dealing with shoulder impingement, our doctors may recommend that you first try to manage the condition with a non-surgical treatment plan. If the issue persists, you may then be asked to go for surgery to alleviate the condition.

Non-Surgical

Non-surgical treatment of shoulder impingement includes a series of exercises that both improve posture and alleviate the impingement. Alternatively, our doctors may recommend steroid injections to help relieve the pain and swelling of shoulder impingement. However, you will still be required to perform the strengthening exercises. 

Surgical 

In the case that neither the exercises nor the steroid injections are helping, and if the symptoms are causing problems with your daily activities such as dressing, washing and/or sleeping, it may be recommended that you have surgery. Surgery for shoulder impingement is called subacromial decompression.

This is a keyhole surgery that involves widening the space surrounding the rotator cuff tendon to prevent it from becoming impinged. 

What is a Dislocated Shoulder?

A dislocated shoulder refers to an injury where your humerus (upper arm bone) pops out of the cup-shaped socket, which is a part of your shoulder blade, where it sits. Should this happen, your joint may become unstable. 

Additionally, you might find that once you’ve had a shoulder dislocation, you may be prone to dislocating it again. 

What Causes a Dislocated Shoulder? 

A number of factors can cause a dislocated shoulder. Typically, it would require a strong blow to the shoulder to shift the bones out of their rightful place. Alternatively, should you rotate your shoulder to the extreme, you may also push the ball of your humerus out of its socket, resulting in a dislocated shoulder. 

Due to the nature of the shoulder joint and its ability to move in various directions, you can dislocate your shoulder either backwards or forwards, downwards, and completely or partially. A partial dislocation refers to a dislocation where the humerus is part in and part out of its socket. 

What are the Symptoms of a Dislocated Shoulder? 

The symptoms related to a dislocated shoulder often include a visibly displaced shoulder and an intense feeling of pain. 

You may experience these symptoms if you are suffering from a dislocated shoulder: 

  • Intense pain
  • Arm feels weak
  • Numbness/tingling reaches down the arm or up the neck
  • Shoulder Spasms
  • Shoulder looks out of place

Dislocated Shoulder Treatment

There are several available treatment plans available should you dislocate your shoulder. There are both surgical and non-surgical options that our doctors will recommend based on your specific case. 

Non-Surgical

Most often, doctors will attempt a closed reduction. This is where the shoulder is manoeuvred gently back into place. You may be prescribed some muscle relaxants or a sedative depending on your level of pain. 

Alternatively, our doctors may recommend that your arm be placed in a sling or a splint to immobilise the shoulder and allow it to rest. Once you can remove the sling or splint, you typically will need some rehabilitation to regain strength in the shoulder and to reduce the chance of re-dislocating it.

Surgical 

In the case that your shoulder labrum (shoulder joint’s socket lip) is torn and your joint is weakened, your sport or working demands may put you at a high risk of dislocating your shoulder again. You may also re-dislocate your shoulder if you have broken part of the shoulder socket.

In these cases, surgery may be recommended to treat a dislocated shoulder. During surgery, our doctors can repair the torn labrum. 

This is commonly done via arthroscopic (keyhole surgery) shoulder stabilisation, where the torn labrum can be repaired.

What is a SLAP Tear?

A Superior Labrum Anterior Posterior Tear (a SLAP Tear) refers to the damage of the top part of the labrum in your shoulder. Your labrum is a cup-shaped rim of fibrous tissue that helps to cushion the shoulder joint’s socket. It is responsible for stabilising the shoulder. The superior labrum is the part that is attached to your biceps’ tendon. 

What Causes a SLAP Tear?

SLAP tears are often the result of repetitive use of the shoulder. Through repetitive overhead use, the labrum may fray or detach. This is why athletes are more likely to suffer from SLAP tears. 

What are the Symptoms of a SLAP Tear?

If you are suffering from a SLAP tear, it is common to feel a deep pain within the shoulder. Additionally, patients often complain of weakness in the arm. 

If you are suffering from a SLAP tear, you may experience these symptoms: 

  • Deep, aching pain 
  • Painful Clicking, Grinding, popping or locking sensation during rotational movement 
  • Decreased shoulder strength
  • Limited range of motion

SLAP Tear Treatment

Similar to the other shoulder conditions mentioned above, there are both surgical and non-surgical treatment plans available for a SLAP Tear. 

Non-Surgical

Non-surgical treatment of a SLAP tear includes anti-inflammatory drugs that will help with the pain and swelling of the injury. Additionally, you will be given a range of strengthening exercises to perform that should both restore your range of motion and strengthen the shoulder. 

Surgical 

A surgical treatment plan for a SLAP tear repair is done arthroscopically, this is also referred to as keyhole surgery. During surgery, the torn part of the labrum is either removed entirely or reattached with stitches. Our doctors will determine which course of surgery is best for you.

What is a Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a common cause of shoulder pain and stiffness that commonly affects patients above the age of 40. A thin capsule usually covers the shoulder joint. When this capsule gets inflamed, it causes pain, and the shoulder becomes stiff. This usually resolves with time.

What Causes a Frozen Shoulder?

As mentioned above, the shoulder joint is covered by a thin capsule of connective tissue. When this connective tissue tightens and thickens, it restricts the movement of your shoulder. This is what causes a frozen shoulder. 

Most commonly, frozen shoulder is a secondary result of underlying shoulder injuries such as shoulder impingement, rotator cuff injury, shoulder dislocation, or SLAP tear. 

Frozen shoulder also tends to occur in people who have recently suffered a shoulder fracture or in cases where the arm has had to be immobilised. 

Additionally, frozen shoulder is also seen in patients with hormonal problems like diabetes and thyroid issues, heart problems like heart attack and neurological problems like stroke. 

What are the Symptoms of a Frozen Shoulder? 

Frozen shoulder tends to develop in stages – freezing, frozen, and thawing. It starts with a pain that is felt when you move your arm, develops into stiffness, and then slowly, your range of movement should improve. 

If you are suffering from a frozen shoulder, you may experience these symptoms: 

  • Stiffness or a dull ache and pain
  • Pain has lasted months
  • Pain reaching the upper arm 

Frozen Shoulder Treatment

Typically, treatment plans for a frozen shoulder are non-surgical. Doctors will usually recommend a non-surgical treatment plan to alleviate a frozen shoulder. However, in a small percentage of cases, you may require surgery. 

Non-Surgical

Non-surgical treatment of a frozen shoulder may involve the injection of corticosteroids that help reduce the inflammation. You may also be prescribed numbing medications to ease the pain of a frozen shoulder. A range of exercises that help with your range of movement may also be recommended. 

Surgical 

Surgery to treat a frozen shoulder is done arthroscopically.  During surgery, the inflamed and thickened joint capsule is cut to allow you to move your shoulder freely.  Often, other shoulder problems like impingement or rotator cuff tears that have resulted in the frozen shoulder will be addressed during the surgery.

What is Shoulder Arthritis? 

Shoulder arthritis refers to damage to the cartilage in the shoulder joints. It occurs when the cartilage starts wearing down on the ball and socket of the shoulder joint, causing pain.

There are various treatment options for arthritis in the shoulder, such as medication, lifestyle changes (such as daily activities or exercise) or physiotherapy. However, if your condition worsens, surgery might be recommended.

What Causes Shoulder Arthritis? 

Shoulder arthritis is the result of the general wear and tear of the cartilage present in your shoulder joint. The cartilage covers the surface of the bones in your joints and allows the bones to glide smoothly over each other when the joints move. As the cartilage begins to break down, the exposed bone may rub against each other and cause you to feel pain. 

The cartilage tends to break down when faced with stress. Therefore, more painful and stressful activities are likely to break down the cartilage more. 

What are the Symptoms of Shoulder Arthritis?

Since the breakdown and loss of cartilage differs in patients, the symptoms also vary. However, patients who suffer from shoulder arthritis generally complain of longstanding pain and stiffness in the joint, and weakness in the arm. 

If you suffer from shoulder arthritis, you may experience these symptoms:

  • Pain in the shoulder joint
  • A weakness of the shoulder
  • Swelling or tenderness at the joint
  • A feeling of grinding within the joint
  • Pain that has lasted months/years

Shoulder Arthritis Treatment

Our doctors will typically recommend non-surgical treatment options if you suffer from shoulder arthritis. However, if non-surgical options show little to no signs of improvement, surgery may be required to improve your condition. 

Non-Surgical

As with many of the other shoulder conditions, non-surgical treatment often involves range-of-motion exercises to strengthen the shoulder, steroid injections to reduce inflammation, and medication to ease the pain. 

However, with the treatment of shoulder arthritis, you may also be told to use ice or heat to alleviate the pain. Speak to our doctors for more information about using cold or hot packs to ease shoulder arthritis pain. 

Surgical 

In the case that non-surgical treatment options are unable to treat shoulder arthritis effectively, surgery may be recommended. Depending on how far along your shoulder arthritis is, our doctors may either recommend shoulder debridement surgery or a shoulder replacement surgery. 

Shoulder debridement surgery is usually recommended for less advanced stages of shoulder arthritis, while a shoulder replacement may be needed in more severe cases. 

Shoulder joint replacements are commonly done for severe arthritis, complex fractures and irreparable rotator cuff tears with limited shoulder function. Dr Bernard Lee employs surgical techniques to help appropriate patients preserve the original shoulder and to avoid a shoulder replacement where possible.

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Find out more about
Shoulder Injuries

  1. Labral injuries
    1. Labral tears
    2. Bony Bankart tears
    3. Superior labral tear
  2. Rotator cuff
    1. Tendinosis
    2. Rotator cuff tear
    3. Calcific tendinitis
  3. Other tendon/soft tissue problems
    1. Biceps tendon
    2. Pectoralis major tendon
    3. Frozen shoulder
    4. Snapping Scapula
  4. Trauma/Fractures
    1. Clavicle (collarbone) fractures
    2. Proximal humerus fractures
    3. Scapula (Shoulder blade) fractures
    4. Acromioclavicular joint dislocation
    5. Sternoclavicular joint dislocation
    6. Glenohumeral joint dislocation
  5. Osteoarthritis
  1. Instability surgery
    1. Anterior Labral repair
    2. Arthroscopic bony bankart repair
    3. Remplissage
    4. Superior labral repair
    5. Bristow-Laterjet Procedure
    6. Capsular plication
  2. Rotator Cuff Surgery
    1. Standard Rotator Cuff Repair
    2. Massive Rotator Cuff Repair
    3. Irreparable rotator cuff surgery
      1. Partial rotator cuff repair
      2. Superior capsule reconstruction
      3. Reverse Total Shoulder Replacement
  3. Other soft tissue disorders of the shoulder
    1. Biceps tenotomy/tenodesis
    2. Subacromial decompression
    3. Pectoralis Major tendon repair
    4. Suprascapular nerve release
    5. Capsular release
    6. Snapping shoulder surgery
  4. Shoulder replacement
    1. For osteoarthritis/rheumatoid arthritis
    2. For cuff tear arthropathy
    3. For complex trauma
  5. Trauma/fractures
    1. Clavicle (collarbone) fracture/non-union fixation
    2. Proximal humerus fracture
      1. Surgical fixation or
      2. Joint replacement
    3. Acromioclavicular joint ligament repair/reconstruction
    4. Sternoclavicular joint ligament repair/reconstruction
    5. Scapula (shoulder blade) Fracture fixation

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