Rotator cuff tear

The rotator cuff is the term used to describe the 4 muscles surrounding the shoulder that help raise and lower the arm.  The muscles lie under the roof of the shoulder, known as the acromion and need to glide freely in this space.  The subacromial bursa, a fluid filled sac, is also found in this space to assist the smooth movement  of the rotator cuff.  

As we get older the rotator cuff tendons that attach the muscle to the bone can start to wear out.  This can result in a tear triggering pain in the shoulder and difficulty raising or lowering the affected arm.  This type of rotator cuff tear is commonly seen and could almost be considered a normal part of aging.  

A rotator cuff tear can also occur following direct trauma to the arm such as falling onto the shoulder or dislocating your shoulder.  This can cause a sudden loss of movement to your shoulder and pain in a previously symptom free shoulder.  This is considered a traumatic rotator cuff tear and requires a review by a shoulder surgeon within 3 months following injury as a surgical repair is often required.  The sooner the repair is done, the better the outcome. 

What are the causes?

Rotator cuff tears are increasingly seen with increasing age due to wear and tear.  It is difficult to be completely accurate but over 30% of people in their 60s will have a rotator cuff tear without knowing about it.  This increases to over 60% of people in their 80s.  Most people can continue to use their shoulder in the early stages as the other muscles around the shoulder compensate for the tear.  

At some stage the muscles start being unable to compensate for the tear.  This could be due to overuse or an injury, such as falling on the affected shoulder or trying to lift a heavy object with the affected arm.  A gradual deterioration in the rotator cuff quality can also lead to symptoms.

What are the symptoms?

Rotator cuff tears cause similar symptoms to subacromial impingement with pain felt over the outer aspect of the shoulder and around the shoulder blade.  The pain can be particularly bad at night and when trying to lift the arm above shoulder height or away from their body.  

Patients can find that they shrug their shoulder when trying to lift their arm to compensate for the weakness caused by the rotator cuff tear.

How is it diagnosed?

An ultrasound or MRI is required to confirm the diagnosis.

How is it treated?

The goal of treatment is to reduce the pain and improve the function in your shoulder.  Physiotherapy can help greatly at increasing the strength of the other rotator cuff muscles to compensate for the rotator cuff tear.  A single injection may help with pain but repeat injections are not advised as this can affect tendon healing.  

If symptoms continue despite physiotherapy then surgery is required to repair the torn tendon.  A rotator cuff repair is usually done through keyhole surgery and involves stitching the torn tendon back to the bone.  Not all rotator cuff tears can be repaired though as the tear may be too large or the quality of the tissue too poor.  Surgery can still be of benefit in this situation but a return to normal shoulder function is unlikely.  Your surgeon can discuss this in more detail with you.