Q&A with Shoulder Surgeon, Mr Mark Pritchard

Affecting a huge portion of 50–70-year-olds, rotator cuff issues can be debilitating. But what exactly is the rotator cuff, and why does it cause so many issues as you get older?

We’ve teamed with orthopaedic consultant, Mr Mark Pritchard from HMT Sancta Maria Hospital, to help you understand degenerative rotator cuff issues.

What is the rotator cuff?

The rotator cuff is a group of muscles around the shoulder that are very important for the movement of the shoulder. The difficulty comes when you get older, these muscles go through a de-generative process where they’re more prone to becoming diseased or even develop holes in them, called rotator cuff tears. While they’re very common, not everyone gets these issues, and not all rotator cuff tears are symptomatic, or problematic for the patient. But when they are, they’re difficult to manage without treatment.

How common are rotator cuff issues?

They’re very common as you get older.  I am a shoulder surgeon and carry-out a variety of procedures relating to shoulder issues, which includes full shoulder and elbow replacements. However, of the 200+ surgeries I perform a year, over 30% of my surgeries are rotator cuff related. I perform 60-100 rotator cuff surgeries a year, that’s how common it is. Most rotator cuff surgeries are carried out in 50–70-year-olds.

What are the tell-tale signs that you may have rotator cuff issues?

Most people tend to present with spontaneous onset of shoulder pain. They have difficulty raising their arm and have night pain. So, you may be kept awake at night, or you can only sleep on one side, and you can’t get comfortable. You may have difficulty putting jackets on and reaching for seatbelts in the car. With ladies, reaching bra straps at the back will often prove to be a big issue, or gentlemen tucking in their shirts at the back.

Rotator cuff pain doesn’t always show true stiffness. Sometimes, early frozen shoulder and early cuff pain are presented very similarly, which is why it’s so important to have a thorough clinical examination. Usually, if people feel very stiff and nothing shows on X-ray, they usually have frozen shoulder as opposed to rotator cuff issues.

What is the diagnostic pathway?

The first thing that’s needed is a consultation. We will take your history and will examine your movement, from there, we should have an idea of what the underlaying issue is and what you’re dealing with.

At Sancta Maria, we can give on the spot X-rays, which are vital in ruling out underlining arthritis or to look for things like calcific tendonitis, which is a deposition of calcium crystals within the tendon, that’s very well seen on plain X-rays. Other modes we use is the use of ultrasound to look at the tendon or MRI scanning. MRI is very useful for a surgeon because you can clearly review the imagery in detail with patients so they can understand exactly what’s going on. It will show us if there is an inflammation within the rotator cuff tendons, right through through to holes in the rotator tendons.

What treatment is available if you have rotator cuff pain, but no tears?

Sometimes, physiotherapy can work with patients without tears but if not, there are a few other options.

A steroid injection inserted just above the rotator cuff tendons can work well. You’ll start with a local anaesthetic injection which bathes the tendon immediately. It aids diagnosis and tells you where the pain’s coming from. You will be examined, have the injection, and then be re-examined. It allows us to see if the anaesthetic has worked and helps us identify where the pain is coming from. Following this, you will receive a steroid injection which takes anything between six to 12 hours to work. It acts as a very powerful anti-inflammatory and is a way of breaking the cycle of inflammation. It’s very important to follow that up with rotator cuff physiotherapy.

What is the treatment if you have a rotator cuff tear?

So, a 50-year-old with a rotator cuff tear is different to an 80-year-old with the same issue. The injection therapy may work well for the older age group, to avoid surgery.

With the surgery route, the majority of surgery takes one to two hours through keyhole surgery and three to four holes. You will be in and out of surgery, and back home, the very same day. To repair a tear, I would use bone anchors, so pegs that go into the bone which I can use to re-stitch the tendon to the bone.

It is usually done via a light anaesthetic, using a regional block. So your arms are numb when you wake. You won’t experience any pain for 24 – 36 hours and you will be given strong pain killers to take once the anaesthetic wears off. This surgery is highly effective.

What support can I get from HMT Sancta Maria after the procedure?

We have an excellent post-operative care package with our team of highly-skilled physiotherapists. They will guide you through exercises to aid your healing and to re-gain strength in your rotator cuff.

What is the recovery process like?

Your arm will be in a sling for six weeks following surgery and you will be advised to do passive exercises, so exercises on the opposite arm. At six weeks, you will come out of the sling and you will re-gain most movement around six to eight weeks following this. At the three-month mark, you can press on and do more strengthening exercises.

Most people are very happy within about six to twelve weeks following surgery, with many of my patients having their first good night’s sleep in years!

What is the back-to-work guidance?

For manual work, unfortunately, you will need three months off due to the nature of the healing process. For those in office-based roles, you can usually go back to work and use a keyboard, mouse or pen two weeks after surgery.

If you would like to arrange a consultation with Mr Pritchard or have any questions relating to the options available to you, please contact HMT Sancta Maria directly by calling 01792 479 040 or by emailing SMEnquiries@hmtsanctamaria.org. More information on all procedures offered at HMT Sancta Maria Hospital can also be found on the website: www.hmtsanctamaria.org.