• Diagnosis
  • Treatment
  • Rehabilitation

Rotator Cuff Tear

Also known as: Rotator cuff disease, Rotator cuff syndrome

Because of their position the tendons of the rotator cuff are vulnerable to being damaged.

As people age it is normal for the rotator cuff tendon to wear and degrade, making it weaker and prone to tearing. A fall or wrenching injury can then result in complete rupture of the tendons.

Tearing can also result from a single large injury such as a shoulder dislocation or repetitive minor injuries when the tendon rubs against the overlying acromion bone (see impingement syndrome).

Sometimes cuff tears can be present without any symptoms - up to 30% of people over the age of 75 will have tears that don’t cause them any disability.

Symptoms

When the tendons or muscles of the rotator cuff tear, the patient is no longer able to lift or rotate his or her arm with the same range of motion as before the injury. Any movement of the shoulder is likely to painful and pain is also very common at night, often radiating down the arm. Sometimes patients will be unable to lift their arm at all.

Investigation

X-rays, ultrasound scan and/or MRI scan to exclude arthritis and confirm the presence and extent of tendon tearing.

Rotator Cuff Tear

In general a tendon tear in younger people should be repaired surgically. This is usually keyhole surgery performed under general anaesthetic.

The operation involves performing a subacromial decompression (creating more room for the tendons to move) and reattaching the tendon to the bone with a combination of sutures (stitches) and bone anchors the size of a matchstick head.

Occasionally tears can be left unrepaired in older patients with low demands on their shoulders.

These patients will have physiotherapy to strengthen their remaining intact rotator cuff muscles.

Rotator Cuff Tear

Post operative management: Once the rotator cuff tear has been repaired there is an intensive strengthening regime designed to increase power and range of movement to the operated shoulder.

The post operative rehabilitation begins with gentle range of movement exercises and postural realignment exercise to put the shoulder blade (scapula) in a better position. This will gently stretch the non operated tissues to ensure the shoulder does not stiffen up.
Then there is a progression to strengthening exercises of the non operated muscles and then finally to strengthen the operated muscles.

Non-operated patients: The main rehabilitation will be intensive strengthening and mobilising exercises for the remaining rotator cuff muscles. Structured and progressive strengthening using the arms weight as resistance as well as theraband will develop a stronger shoulder complex. The physiotherapist will also use manual therapy (hands on stretches) to assist the shoulder movement and posture.

Good posture is important to be re-educated to the shoulder to allow the rotator cuff tendons to strengthen and stretch without scraping against the bone in the sub-acromial space again.