The rotator cuff is a group of 4 tendons that connect the muscles of the shoulder blade to the top of the humerus bone (humeral head). They function as a unit to keep the humeral head centred in the joint, but also provide stability to the shoulder and strength with certain movements. Due to the complex structure of the shoulder joint and the stresses placed upon it, these tendons are very vulnerable to injury. Tears of the rotator cuff tendons most commonly occur at their attachment site. When this occurs, the tendon retracts from the bone, effectively leaving a ‘hole’ in the rotator cuff. As a result of this retraction a rotator cuff tear will never heal by itself.
Rotator cuff tears are one of the most common causes of shoulder pain in middle-aged and older individuals.
Tears of the rotator cuff can range from minor partial thickness tears in one tendon to full thickness (complete) tears of one or more tendons. In a partial thickness tear only some of the tendon fibres are torn. This weakens the tendon and can cause significant pain. Over time a partial thickness tear can progress to become a full thickness tear. Full thickness tears can also be the result of trauma. Symptoms will vary depending on the extent of the tear but will usually include pain with active use of the arm, night pain, and weakness of the arm. Full thickness rotator cuff tears can also occur due to the normal wear and tear of age, with approximately 30% of patients over the age of 70 years having a tear.
What are the Symptoms of Rotator Cuff Tears?
A rotator cuff tear may cause pain, weakness of the arm and a sharp catch or crackling sensation on moving the shoulder in certain positions. The pain is often felt down the side of the upper arm and tends to be worse with use of the arm (especially at or above shoulder height) and at night.
How is a Rotator Cuff Tear Diagnosed?
Your surgeon can usually diagnose a rotator cuff tear based on a history and physical examination However soft tissue imaging is usually always required, either with an ultrasound or preferable an MRI. An ultrasound can tell the presence or absence of a full thickness tear; an MRI gives significantly more detail about a tear including tear size, degree of retraction, and what the muscle belly of the tendons are like.
Treatment Options for Rotator Cuff Tears?
Because the tendon does not heal by itself non-operative treatment is purely symptomatic treatment. It aims to reduce pain and inflammation in the shoulder and get the remaining rotator cuff muscles working more effectively. This form of treatment includes anti-inflammatory medications, cortisone injections, and exercises to strengthen the rotator cuff and scapula muscles. Although this form of treatment may be effective in managing partial thickness tears and small full thickness tears, it rarely results in long term benefit for larger full thickness tears, especially in younger patients.
The primary aim of surgery is to restore shoulder function and comfort by reattaching the tendon(s) to the bone. This is done by using little absorbable ‘suture anchors’ which are inserted into the bone. The sutures from these anchors are then used to attach the tendon back to the bone. The procedure normally takes from 60 to 90 minutes and is most commonly done through keyholes (arthroscopic), or occasionally through a small cut over the top of the shoulder. If any other damage is found at the time of surgery (bone spurs, bicep tears, AC joint arthritis) then these will be addressed at the same time. Rotator cuff repair is normally a very safe and successful operation, and it is the most common operation that I do, but it does involve a very long recovery and rehabilitation period.