Rotator Cuff Tear

What is your Rotator Cuff?

Your rotator cuff is a group of muscles around your shoulder joint. These muscles help you move your shoulder in all directions, especially when lifting your hand above your head and rotating your shoulder. They also have the important function of keeping your shoulder joint in place. Without them, the ball of your shoulder joint, would not sit or function properly in the socket of your shoulder joint.

4 muscles make up your rotator cuff

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres Minor

What is a Rotator Cuff Tear?

A rotator cuff tear is a tear of the tendons on the rotator cuff, near to where the tendons attach to the top of your humerus (upper arm bone). The most common tendon affected is the supraspinatus tendon.

Rotator cuff tears can occur with a fall or some other trauma. However, most Rotator Cuff Tears, occur with repetitive arm activities or as a ‘Wear and Tear’ process with ageing. The older you get, the more common it becomes.

Young people can also get rotator cuff tears from falls, trauma and sporting injuries. However, this is much less common.

People who are particularly prone to having rotator cuff problems are those who use their arms in repetitive movements above their shoulder and head. For example, painters, tennis players, weight lifters.

What are the symptoms of a Rotator Cuff Tear? 

  • Pain and tenderness 
    • The pain around your shoulder, usually around the side or front 
    • It is worsened when reaching overhead or behind your back. Activities such as combing your hair, hanging up the washing or doing up a bra may be extremely difficult. 
    • As the symptoms worsen, you may have difficulty sleeping, especially on the affected side.
  • Shoulder weakness
    • You may experience difficulty moving your arm, especially when trying to lift it
    • Many people find it hard to lift their arm above shoulder height
  • Shoulder stiffness
    • You may be restricted in how far your arm can move.

Causes 

  • Normal wear and tear. As you get older, your tendons undergo an ageing process which makes them more prone to degeneration and injury. The older you get, the more likely you are to have a rotator cuff tear.
  • Repetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles causing them to become irritated. This causes inflammation and may eventually lead to a tear in the rotator cuff. This can occur in certain occupations (painters) or certain sporting activities (tennis players) 
  • Injuries. Falling on your arm can injure your rotator cuff. 
  • Lifting or pulling. Lifting an object that’s too heavy or doing so improperly — especially overhead — can strain or tear your rotator cuff.

What are the risk factors? 

  • Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
  • Certain Sports. Athletes who regularly use repetitive motions, such as tennis players, have a greater risk of having a rotator cuff injury.
  • Certain Jobs. Carpenters, painters and other tradesman, who also use repetitive motions, have an increased risk of injury.

Are tests are used in diagnosing rotator cuff tears? 

A Xray of the Left Shoulder showing normal anatomy

  • X-rays. A X-ray of the shoulder will help you doctor determine the cause of your shoulder pain. For example, it will help to determine if your pain is due to shoulder arthritis, rotator cuff problems or AC joint problems. Your doctor can look for other problems like bone spurs and calcium deposits.
  • Ultrasound Scan. An ultrasound scan can diagnose rotator cuff tears. It is painless and easy to obtain. However, it can sometimes be inaccurate.
  • MRI Scan. A MRI scan is the most accurate test. It can accurately show the size and location of the tear, and help decide if the tear is repairable or not. It can also show other problems in the shoulder such as:
    • Arthritis of the AC joint
    • Bicep tendon problems
    • Shoulder joint labrum problems

Complications

  • Pain and Disability. A rotator cuff tear should only generally be treated if it is painful and causing trouble. Many people cope well with a rotator cuff tear. However, for some people, an untreated rotator cuff tear can lead to ongoing pain and dysfunction of the shoulder.
  • Arthritis. Sometimes a complete tear of the rotator cuff can lead to arthritis of the shoulder joint.

Treatment 

Nonsurgical Options

A minor injury to the rotator cuff often heals on its own, with proper care. 
If you think you’ve injured your rotator cuff, try these steps:

  • Rest your shoulder. Stop doing what caused the pain and try to avoid painful movements. Don’t lift anything heavy or use your arm above your head for 1 week until your shoulder starts to feel better. 
  • Take pain relieving medications. Over-the-counter pain relieving medications such as paracetamol or ibuprofen may help reduce pain and inflammation. Follow label directions and stop taking the drugs when the pain improves.
  • Exercises. After one or two days of rest, gently start moving your shoulder. Keeping your arm immobilized for prolonged periods can lead to a stiff shoulder. After the pain settles down, daily shoulder stretches and a balanced shoulder-strengthening program can help prevent a recurrence of your injury. 

Exercises and Physiotherapy. Most of the time, rotator cuff injuries can be improved by physiotherapy and exercise. A physiotherapist can talk to you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles, and provide balanced shoulder muscle strength. Depending on the severity of your injury, physiotherapy may take several months. 

Steroid and Local Anaesthetic injections. An injection of local anaesthetic and corticosteroid injection can relieve your inflammation and pain. Having an injection and physiotherapy is an effective way of reducing the pain of rotator cuff tears.

Surgery

If your pain is not improved with rest, exercises, physiotherapy and injections, then surgery may be a good option for you.

Rotator Cuff Repair. A rotator cuff repair is surgery to repairs the torn rotator cuff tendon back into the humerus. During the surgery, the surgeon often removes a inflamed bursa and a bone spur from the acromion (a procedure called a subacromial decompression). If needed, a surgeon can also perform a:

  • biceps tenodesis or tenotomy
  • shoulder arthroscopy
  • AC joint excision

Shoulder Replacement. Some patients with a long standing large rotator cuff tear can develop osteoarthritis of the shoulder.

This is called rotator cuff arthropathy.

Your surgeon may suggest a shoulder replacement if your osteoarthritis is severe.

A Rotator Cuff Tear viewed from inside the shoulder joint with a special camera called an Arthroscope.

Seeking Advice

Your Family Doctor (GP)

Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to

  • tell you about your problem
  • advise you of the best treatment methods
  • prescribe you medications
  • and if necessary, refer you to Specialists (Consultants) for further treatment

What you can do in the meantime


In the days before your appointment, you can make yourself more comfortable by:

  • Resting your shoulder. Avoid movements that aggravatethe pain. 
  • Pain relievers. Taking pain relieving medications, if necessary. There are Over-the-counter medications, that can be bought without a prescription from a doctor, that can help relieve your pain. These include:
    • Anti-inflammatory medications (called NSAIDs) such as ibuprofen 
    • Paracetamol 

Preparing for your appointment
You’ll start by seeing your family doctor (GP). If your injury is severe and requires surgery, however, you’ll likely be referred to an orthopaedic surgeon.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

* Where is the pain located?
* Does your job or hobby aggravate your shoulder pain?
* When did you first begin experiencing shoulder pain?
* Have you experienced any symptoms in addition to shoulder pain?
* How severe is your pain?
* What movements and activities aggravate and relieve your shoulder pain?
* Do you have any weakness or numbness in your arm?

What you can do in the meantime
In the days before your appointment, you can make yourself more comfortable by:

* Resting your shoulder. Avoid movements that aggravate it and give you more pain.
* Applying cold packs to reduce pain and inflammation.
* Taking pain medications, if necessary. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and may help reduce pain. paracetamol also may help relieve pain.

Prevention

Unfortunately, rotator cuff disease is often associated with becoming older.

However, you can decrease the chance of having it by:

  • Avoiding repetitive overhead activities. Rotator cuff disease is more common in certain sports and occupations. 
  • Exercises. Do regular shoulder exercises that balance your shoulder muscles.
  • Rest your shoulder. Take frequent breaks at work if your job requires repetitive arm and shoulder motions.Rest your shoulder regularly during sports that require repetitive arm use.

Shoulder Exercises. Daily shoulder stretches and a shoulder-strengthening program can help treat and prevent a rotator cuff tear, especially if you’ve had a tear in the past.

It’s especially important to concentrate on all the muscles around your shoulder, as this promotes a balanced shoulder.

A physiotherapist can help you with an exercise routine.

F.A.Q. | Frequently Asked Questions

  • What is the Rotator Cuff?
  • What is a Rotator Cuff Tear?
  • What are the causes of a Rotator Cuff Tear?


Research on the Horizon

Future developments in the treatment of rotator cuff disease include newer arthroscopic surgical techniques. These allow for smaller, less painful incisions and a faster recovery time.

Many techniques now use dissolvable anchors. These hold stitches in place or hold stitches in bone until the repair has healed. They are gradually absorbed by the body.

Research is also being done on ” orthobiologic ” tissue implants. These promote growth of new tissue in the body, and help with the healing process.