The rotator cuff is a group of muscles which help control, stabilise and function the shoulder joint. It is made up of four muscles: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. These muscles are close to the shoulder joint and lie deep to the larger muscles you see in your chest, shoulder and arm.

Causes

The exact nature of rotator cuff tears can be hard to determine, although the broad types of tearing to the rotator cuff are traumatic (acute injury) or degenerative (wear and tear). Degenerative type tears are the most common, and become more common as people get older.

In traumatic tears for example if you fall on your outstretched arm, or lift something too heavy with a jerking motion; injury causes separation of the attachment of the tendon from its insertion to the bone of the shoulder (humerus). These tears may be associated with a dislocation of the shoulder in adults or other high energy injuries. They are often large tears, and frequently require surgical repair.Degenerative tears occur over time, the tendon insertion gradually tears away from the humerus, eventually leading to a full thickness tears. These tears tend to progress more slowly, although they can progress more rapidly with the addition of a new injury (acute on chronic tear). Degenerative tears do not always cause pain in the initial stages, although often pain can develop with time. Repetitive stress of the rotator cuff and lack of blood supply to assist with the body’s natural ability to repair are contributing factors to degenerative tears.

Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history. Examination generally reveals weakness of the rotator cuff musculature (weak shoulder movements) and pain on raising the arm above the head. Further imaging, for example MRI or Ultrasound scan is used to confirm diagnosis.

Treatment Options

Treatment of rotator cuff tears involves both non-surgical (conservative) and surgical management depending on the exact nature of the tear and the patient presenting with it.

Non Operative Treatment

When tears are small and pain is minimal with a chronic tear, an initial attempt at non-surgical management may be attempted. Rest and limiting overhead activities with activity modification is important. Pain killers (paracetamol or panadol osteo) and anti-inflammatories if tolerated and not contraindicated may also be recommended. Physical therapy including stretching exercises to improve range of motion are helpful and can help relieve pain. Corticosteroid injections may also help relieve pain and reduce inflammation. In these circumstances the tear will not heal itself, but patients may be able to function well without repair of the tendon.

Surgery

In traumatic rotator cuff tears, larger rotator cuff tears or where more conservative management has failed, your Dr du Sart may recommend repair of the rotator cuff tendon to restore functionality to the rotator cuff. The torn tendon is re-attached to the bone, and a sling is used for a period of time after surgery to allow the tendon to heal. Dr du Sart prefers to utilise arthroscopic techniques (key hole surgery) for rotator cuff repair, enabling the surgery to be completed via smaller incisions equating to less post-operative pain and a faster recovery. 

Find out more about Rotator Cuff Repair.