Rotator cuff tear in Vienna
At night a dragging pain in the outer upper arm wakes you; during the day the strength is missing when you lift overhead. Behind this there is often a tear in the tendon cap of the shoulder. At my practice at the Orthozentrum Döbling I establish the cause and discuss with you whether treatment stays conservative or a repair makes sense.
In short
The rotator cuff is a cap of four muscles and their tendons; it centres the humeral head in the shoulder socket and lifts and rotates the arm. When one of these tendons tears — usually the supraspinatus tendon — through wear or through an accident, the typical result is night pain and a loss of strength when lifting overhead. I make the diagnosis from the conversation, the clinical examination and ultrasound; I arrange an MRI when the size of the tear and the quality of the tendon have to be judged precisely. Depending on the findings, treatment is conservative or an arthroscopic repair. Which path fits depends on your age, the size of the tear, the quality of the tendon and the demands you place on the shoulder.
What is a rotator cuff tear?
Four muscles enclose the humeral head like a cuff; their flat tendons insert on the bone. This tendon cap holds the head centred in the shoulder socket while the deltoid muscle raises the arm. At the upper edge lies the supraspinatus tendon; it runs through a narrow space under the acromion and is affected particularly often.
A tear arises through wear — the tendon tissue turns brittle over the years and gives way during an everyday movement — or through an accident, a fall onto the arm for instance. In a partial tear only part of the thickness of the tendon is affected; in a complete tear the tendon is divided and retracts from the bone, where it does not grow back on its own. Some tears stay silent for a long time, others hurt severely from the outset.
Typical symptoms
- Night pain — it draws into the outer upper arm and grows worse when lying down.
- Loss of strength overhead — washing your hair or taking something from a high shelf becomes hard.
- Pain when lifting the arm sideways — within a certain part of the arc, easing again above it.
- Weakness on rotation — strength falls away when turning the arm outwards and inwards.
- Sudden loss of function after a fall — this should be assessed promptly.
How I make the diagnosis
It begins with a thorough conversation, followed by the clinical examination. Range of movement, the strength of the individual parts of the cuff and specific tests separate tendon damage from other causes of shoulder pain, such as a stiff capsule or calcific tendinitis. Ultrasound is available in the practice: with it I assess the tendons in motion and see tears, fluid in the bursa and calcium deposits while we are still talking. Where needed I arrange an X-ray or an MRI — both outside the building; I then go through the findings with you.
Treatment: conservative first
Not every tear has to be repaired. With partial tears caused by wear, and where little is asked of the shoulder overhead, I begin conservatively. The aim is to relieve the pain and to strengthen the remaining parts of the cuff so that the humeral head is guided again.
- Physiotherapy and exercise therapy — the most important element, available in-house at the Orthozentrum Döbling.
- Ultrasound-guided injection — placed precisely, to settle a painful irritation.
- Shockwave therapy — focused and radial, where the tendon insertion is irritated as well.
- PRP therapy — an additional option for partial tears and irritated tendons.
- Magnetic field therapy — as support when the shoulder is strongly irritated.
If pain and function improve, we stay on that course; I follow the findings with ultrasound.
When an operation is necessary
Whether an operation makes sense depends on the findings. In favour of a repair are a fresh tear caused by an accident, a marked loss of strength and high demands from work or sport; against it are tendons that have retracted far with fatty muscle. Age, the size of the tear, the quality of tendon and muscle and your own goals all feed into the decision, which we take together once all the findings are in.
As a rule I carry out the repair arthroscopically: through small incisions I place suture anchors in the humeral head and draw the tendon back to its insertion. I treat accompanying findings in the same procedure; I explain separately how an arthroscopy of the shoulder proceeds.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on this under private practice in Vienna and with the shoulder specialist in Vienna.
Frequently asked
Frequently asked questions about rotator cuff tears
A tendon that has torn right through does not reattach to the bone by itself. Even so, many people manage well in daily life with a tear, provided the remaining parts of the cuff keep the humeral head centred and the muscles are built up in a targeted way. I assess whether that is realistic in your case after examination and ultrasound.
Self-observation cannot separate the two reliably. A sudden loss of strength after a fall, persistent night pain in the outer upper arm and the feeling that you can no longer actively hold the arm above your head point towards a tear. Clarity comes from the clinical examination and ultrasound.
No. The clinical examination and ultrasound are often enough to demonstrate a tear and to plan conservative treatment. I arrange an MRI when the size of the tear, the retraction of the tendon and the quality of the muscle have to be known precisely — above all when an operation is under consideration.
When the tear is fresh and caused by an accident, when strength is noticeably missing, or when the symptoms persist under conservative treatment and work or sport place high demands on the shoulder. A tendon that has retracted far, with fatty muscle, argues against a repair. We weigh this up together.
As a rule arthroscopically, that is through small incisions. Suture anchors in the humeral head hold the threads with which I draw the tendon back to its insertion and press it down there. I remove inflamed tissue in the same procedure. I use open techniques only when the findings require it.
The repaired tendon has to be protected at first. You wear a sling to begin with, move the shoulder under guidance and load it actively again only step by step. I set the aftercare plan individually, discuss it with you before the procedure and carry out the check-ups myself.
The aim of treatment is a shoulder that carries load with little pain. Whether you reach your former level depends on the findings and on how consistently the build-up phase is seen through. I know the demands of strength and contact sport from my own sporting experience, and I plan the return with you.
Bring everything you have: your e-card, previous findings, doctors' letters and X-ray, CT or MRI images. You do not need a referral. You receive an invoice and submit it to your insurer; for operations, direct settlement with a supplementary private insurance is possible.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.