What is a rotator cuff tear?

A rotator cuff tear occurs when the muscles around the shoulder (rotator cuff) sustain a tear.

This may be the result of trauma or as a natural consequence 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 for the tear.

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). When activated the rotator cuff muscles provide significant tension across the joint and thereby:

  • Stabilise the humeral head (ball of the shoulder joint) in the centre of the glenoid (socket of the shoulder joint). This helps to prevent dislocation to the joint.
  • Allows more powerful muscles around the shoulder to provide the tension needed to move the shoulder.
  • Provide movement and control into rotational positions for the shoulder.
Rotator cuff tear

Common symptoms

Most commonly, there is shoulder pain and weakness. Commonly, individuals may suffer from referred pain radiating down the upper arm to the elbow. Weakness may result in an inability to lift the arm and affect activities of daily living such as dressing.

Pain on movements of the arm above the head, behind the back and across your body are the main aggravating activities. Lifting any significant weight with these movements will normally increase symptoms further.

If there is a significant rotator cuff tear then there may be significant weakness to shoulder movements resulting in an inability to move the shoulder in the direction of the affected muscle.

How is a rotator cuff tear diagnosed?

A rotator cuff tear can be diagnosed by your doctor or physiotherapist by taking a history of your condition 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.

How Is a rotator cuff tear treated?

Non-surgical Management

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.

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 management

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

Further information

The Shoulder Doc