Rotator cuff tear after an accident?
I crashed my bike and fell on my outstretched arm. Now I can't move it properly and it hurts. Is waiting the right thing to do?
Falling on the outstretched arm is one of the most common causes of shoulder accidents. The rotator cuff is usually affected. If it feels like a bruise but doesn't get much better after a few days, then it's time to see a specialist. The tendons of the shoulder muscles can be completely or partially torn away from the humerus in such a fall.
The rotator cuff consists of 4 muscles and their tendons, which run from the shoulder blade over the humeral head to its side. The muscles are attached to the shoulder blade, the tendons are attached to the upper arm. They serve to hold the humeral head in the joint during movements so that it cannot dislocate. And they help to move the arm. The tendons have to cope with unbelievable lever arms and are coarse and non-stretchable. They also have no blood supply of their own, which is why they are most likely to tear and take a long time to heal.
A tendon does not always tear completely from the bone. Sometimes only one layer of the tendon tears, sometimes only individual fibres. In any case, the tear hurts. If a tendon is completely torn, you can no longer lift your arm properly. Over time, the pain goes away and you learn to deal with it. This is why many patients go to the doctor too late. If a tendon is only partially torn, the function often remains intact, but so does the pain. This is because every time you lift your arm, you pull on the tear again.
When does a rotator cuff tear need to be operated on?
If a tendon is only partially torn, it may be worth trying conservative therapy, especially physiotherapy, depending on the situation. This helps to normalise movement and thus also treats the pain. However, it is often the case that a tear after an accident is very poorly tolerated and conservative measures are also ineffective. Surgery is then unavoidable.
Minimally invasive surgery can be used to reattach the torn tendon. It is performed using keyhole surgery. The patient is given a general anaesthetic so that the muscles are relaxed. Approximately 4 mm instruments and an equally large camera are used to enter the joint and suture the torn tendon to the bone on the humeral head where it belongs. In most cases, the bursa under the acromion is also removed to create space.
How long does the hospitalisation last and what happens afterwards?
You recover very quickly from this operation. The arm is no longer immobilised after the operation, but must not be used at first. The stay in the clinic lasts 3 days and includes physiotherapy from the outset. This therapy continues after leaving hospital. Strength building can begin after 6 weeks. However, it will take several months before the shoulder is fully recovered.
Does accident insurance pay for the operation?
Not every rotator cuff tear is caused by an accident. Some are also caused by wear and tear. This is difficult for accident insurers to distinguish, which is why they occasionally reject cases that appear to be clear-cut. We are happy to help in such cases.
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Dr Andreas L. Oberholzer is an experienced FMH specialist in orthopaedics and trauma surgery.
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PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.