The rotator cuff tendons cover the head of the humerus (upper arm bone), attaching it to the shoulder blade and enabling you to raise and rotate your arm. The rotator cuff keeps your arm within your shoulder socket and has a lubricating sac, called a bursa, which allows it to slide smoothly as you move your arm. If you damage your rotator cuff tendons, the bursa may also become inflamed and painful.
What is a rotator cuff tear?
The rotator cuff may fray over time and become torn, detaching partially or completely from the upper arm bone. There are different causes for rotator cuff damage.
Chronic tears: Most are the result of age-related wear and degeneration of the tendon, particularly in the dominant arm, which tends to get most use. These are called chronic or degenerative rotator cuff tears. They are associated with repeated stress – using the shoulder again and again to make the same movement, for example throwing a ball or using a roller or paintbrush. Athletes and certain manual labourers may be at particular risk.
Acute tears: Some rotator cuff tears are due to a fall onto your outstretched arm or lifting something that is too heavy, particularly if you use a sudden jerking movement. These are called acute rotator cuff tears. This type of injury may be accompanied by a dislocated shoulder or a fracture of the collarbone or wrist.
Symptoms of a rotator cuff tear
Rotator cuff tears vary in severity. If you experience an acute rotator cuff tear you may experience intense pain, weakness in your upper arm and, sometimes, a snapping sensation. In contrast, chronic rotator cuff tears may develop gradually.
At first, the pain may be mild and you might notice it only when performing certain movements such as lifting your arm above your head.
As time goes on, however, the pain is likely to worsen and you may find it hard to perform routine activities like brushing your hair. Your arm may feel weak and it might be hard to lie on the painful side at night.
Treating a rotator cuff tear
Rotator cuff tears are diagnosed using imaging tests, such as X-rays, MRI scans or ultrasound. These can show the location and extent of the tear and help to determine the most appropriate type of treatment.
Non-surgical treatment: In around 80% of cases, a torn rotator cuff can be treated non-surgically. You will need to rest the affected shoulder and avoid activities that cause pain. Painkilling medication can help you manage the symptoms and you may be offered an injection of steroids into the affected joint to relieve pain and inflammation, although the latter may not be recommended if you are physically healthy and have a full tear. Physiotherapy exercises to strengthen the muscles that support your shoulder can help to relieve pain, as well as improving flexibility and range of motion.
While non-surgical treatment avoids the risk of surgical complications (which include infection, permanent stiffness or lengthy recovery), there is a possibility that the tear might increase in size over time, or not respond well to non-surgical treatment.
Surgical treatment: If symptoms have lasted for six to 12 months without clear signs of improvement, your arm is very weak, and your quality of life is significantly impacted, your doctor may suggest surgery to repair the torn rotator cuff. Surgical options may include:
Surgical treatment: If symptoms have lasted for six to 12 months, or the tear is 3cm or larger, or if your quality of life is significantly impacted, your doctor may suggest surgery to repair the torn rotator cuff. Surgical options may include:
- Open surgery which involves making an incision over the shoulder. The tendon is then repaired, if possible, or you may require a tendon transfer. Bone spurs may be removed from the underside of the acromion.
- Arthroscopy which entails making a much smaller incision through which the surgeon inserts a small camera called an arthroscope. This enables them to see inside your shoulder joint and they can then use tiny surgical instruments to repair the tear. Because this is a minimally-invasive procedure, recovery times tend to be quicker and the risk of infection lower.
- Mini-open repair uses arthroscopy to assess the damage and treat other structures within the joint. Afterwards, the rotator cuff is repaired using open surgery, although via a smaller incision than with conventional open surgery.
The options for irreparable rotator cuff tears
In some cases, however, it may not be possible to repair a damaged rotator cuff. This is normally because of the severity of the damage or the fact that the shoulder has become arthritic, which is referred to as rotator cuff tear arthropathy.
If the tear is particularly large, has been present for a long time or is accompanied by shoulder arthritis, surgical repair may not be an option as the tendon may have contracted and it might not be possible to reattach it. The muscles surrounding the rotator cuff may also have weakened, meaning they would not function correctly even if the tendon could be repaired.
If a rotator cuff tear is irreparable, your doctor may offer alternative surgical options including:
- Shoulder debridement surgery which uses arthroscopy to remove damaged or inflamed tissue, clean out loose cartilage and smooth any uneven surfaces.
- Partial rotator cuff repair is sometimes performed alongside shoulder debridement. This involves making a partial repair to reduce the size of the tear and restore some function to the shoulder joint.
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Tendon transfer entails taking tendons from elsewhere in the shoulder and using them to replace the damaged rotator cuff.
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Tendon graft uses donated tendon or tissue attached the bones and/or remaining tendon to try to restore the function of your muscles
- Reverse shoulder replacement surgery is used where the rotator cuff is damaged beyond repair and the shoulder has become arthritic. This involves removing the damaged shoulder joint and replacing it with an artificial implant. The mechanics of the shoulder are altered to allow it to function in spite of ongoing damage to the rotator cuff.
For more information about rotator cuff tears, including treatment options for the most severe damage, contact us.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
