Rotator cuff tear
A rotator cuff tear occurs when the muscles around the shoulder (rotator cuff) develop a small hole, usually in the tendon of the muscle. This can This may be the result of trauma or as a natural part of the ageing process. Although the tear itself won’t heal, in the majority of cases, the pain settles over time and the other parts of the rotator cuff are able to strengthen and compensate.
The rotator cuff refers to a group of tendons and muscles in the shoulder which attach the scapula (shoulder blade) to the humeral head (upper arm bone). The rotator cuff muscles provide significant tension across the joint;
- Stabilising the humeral head (ball of the shoulder joint) in the centre of the glenoid (socket of the shoulder joint), allowing for a large range of joint movement.
- Allowing more powerful muscles around the shoulder to provide the tension needed to move the shoulder.
Most people tell us that they experience shoulder pain and weakness. The pain is often felt in the upper arm to the elbow. Some people may also experience a loss of muscle strength, which can vary in severity. For some, this weakness may result in an inability to lift the arm at all, whilst for others it might only be noticeable when they are trying to lift things.
Pain on movements of the arm above the head, behind the back and across your body are usually the most painful movements. Lifting any significant weight with these movements will normally increase symptoms further.
A rotator cuff tear can be diagnosed by your clinician by talking to you about your symptoms and by conducting a physical examination.
The main features on examination are often pain and weakness when resisting rotational movements and movements of the arm away from the side.
An ultrasound scan may be required to assess the extent of any rotator cuff tear. This may guide future management including a possible surgical repair.
X-Rays are often used to make sure there is no bone/joint involvement, but this is more commonly reserved for people who are considering surgery.
How Is a rotator cuff tear treated?
In the event of a rotator cuff tear being sustained through injury a period of watchful waiting may be appropriate to assess the degree of spontaneous recovery prior to deciding on any necessary intervention.
Exercises. A rotator cuff tear can be managed effectively by following a regular exercise routine to optimise strength and coordination of the affected shoulder joint:
5×30 second holds, 2x per day
3×10 repetitions, 3-4x per week
5×15 repetitions, 2x per day
Using painkillers when needed. Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Arthritis Research UK website with information about the various drug options.
Physiotherapy can be offered as a treatment option for shoulder pain. This involves a physical assessment and discussion about how your symptoms are impacting your life, followed by developing a treatment plan together. Treatment can include:
- Exercises form the mainstay of treatment, with advice regarding exercises to improve flexibility and reduce the sensitivity of the muscles, joints and nerves. Some strength exercises can also be recommended to help improve the strength and function of the tendons and shoulder joint.
- Manual Therapy, such as manipulation, mobilisations and soft tissue massage. This usually forms a small portion of your treatment.
- Advice to help you speed your recovery and avoid aggravating symptoms.
Corticosteroid injection therapy. These are best avoided in the presence of a rotator cuff tear but may be considered by your clinician in specific circumstances.
Surgical rotator cuff tendon repair is a highly invasive operation which normally requires 4-8 weeks’ immobilisation of the operated shoulder and extensive, prolonged rehabilitation following surgery. As such, many individuals may opt to manage the condition non-surgically even if there is some reduction in their ability to use the arm.
For patients who are willing to consider a surgical repair this decision is best discussed with your clinician as the effectiveness of this operation varies greatly according to individual characteristics:
- Patients age; Outcomes after rotator cuff repairs worsen with increasing age. Your clinician will discuss the implications of this at your consultation
- The exact location and size of the tendon tear (partial thickness tears will need to have trialled at least 3 months of non-surgical management before considering surgery
- Whether the tendon tear was traumatic (through an injury) or degenerative (age-related) in nature