Rotator cuff injuries are extremely common. Nearly three quarters (roughly 70%) of all visits to the doctor by UK patient with shoulder pain are due to rotator cuff problems.
Your rotator cuff is a group of muscles and tendons around your shoulder joint. Their role is to stabilise the shoulder and keep the ball at the top of the humerus bone firmly centred in your shoulder socket. Some of them also contribute very significantly to rotational movements of the shoulder joint.
What causes rotator cuff tears?
You use your rotator cuff every time you lift or rotate your arm, so it is hardly surprising that it is particularly at risk of wear and tear injuries. Your rotator cuff degenerates naturally as you age and injuries are most common in people over the age of 60. Ageing means that less blood reaches the rotator cuff area so any tears that do occur are harder to repair and this can lead to larger tears. The development of bone spurs can also occur in older people and these can wear away the tissues of the rotator cuff, leading to tearing.
If you work in certain types of job that involve making repeated arm movements (such as a painter and decorator or carpenter) you are more at risk of rotator cuff injuries or if you play certain types of sport, such as racket sports.
The rotator cuff can also tear as a result of an accident or through wear and tear. The age at which the latter occurs seems to be related to the bone structure of the shoulder blade and socket. The greater the difference of this shape from the normal population the earlier the rotator cuff will wear out, and can occur at any time from the age of forty onwards. It is now possible to perform a 3D analysis of shoulder bone structure based on an MRI scan, which will give your doctor information about the likelihood of a tear developing and progressing.
Types of rotator cuff injury
Rotator cuff injuries range in severity from mild inflammation to a complete tear. We commonly see three main types of rotator cuff problems:
- Tendinopathy is disease of the rotator cuff tendons caused by injury or overuse. If there is inflammation this is called tendinitis, if there is no inflammation it is called tendinosis.
- Bursitis is inflammation of the bursa which is the naturally occurring fluid-filled sac that cushions the rotator cuff tendons from the overlying bone. It always occurs secondary to the underlying rotator cuff problem and is not the primary issue.
- Rotator cuff tears occur when the tendons connecting the shoulder blade to the humerus in the shoulder joint become torn. You may experience a partial tear, when one of the muscles become frayed or damaged, or a fulltear when a tendon tears or is pulled off the bone. Full tears do not heal back to the bone naturally but, paradoxically, the symptoms very often get better given enough time.
Symptoms of rotator cuff injury
If you injure your rotator cuff you may experience pain, which can be severe, and is normally worse when you move your arm or lie on it. The pain is often hard to pin point, but most often is predominantly felt over the outer part of your upper arm, rather than over the shoulder itself. Your shoulder may feel weak and you might have problems raising your arm or hear a clicking noise.
Leaving a rotator cuff tear untreated can lead to the tear getting larger. In the worst case scenario this can lead to shoulder arthritis, which can cause serious long-term loss of flexibility and ongoing pain and stiffness. For this reason, it is important to seek treatment for rotator cuff injuries.
What should I do if I suspect a rotator cuff tear?
In the first instance, it’s important to get a proper diagnosis so you know what is causing the problem. You may be referred for different types of diagnostic imaging – MRI, ultrasound or X-ray – to determine whether you have a tear and if so, how severe it is.
You will need to rest to allow your symptoms to improve. If the problem is relatively minor, you may be offered non-invasive treatments such as physiotherapy. Anti-inflammatories or steroid injections into your shoulder joint are available to provide pain relief whilst you work with a physio to rehab the shoulder.
Treatment of a rotator cuff tear
If you have a complete tear which is causing profound weakness or failing to improve with time and physiotherapy, you may need surgery. There are different types of rotator cuff surgery including:
- Arthroscopic repair, which uses a fibreoptic camera called an arthroscope and tiny surgical instruments, inserted through small incisions in your shoulder, to reattach the torn tendon(s) back onto the bone using devices called bone anchors.
- Open repair, which is a conventional surgical procedure involving a larger incision. Nowadays, with advancements in arthroscopic technique, this is becoming a rarer procedure.
If the tear is so advanced or severe that it is not directly reparable then an alternative procedure will be required:
- Tendon transfer and superior capsule reconstruction. These procedures use either another tendon from nearby or a donated tendon, and uses it to replace the torn tendon. They are only suitable if part of the rotator cuff is still reparable and there is no arthritis in the joint.
Shoulder replacement, which is for the most severe rotator cuff tears and in those where arthritis has set in. It involves replacing the entire shoulder joint with an artificial implant, specially designed to work with the muscles that are not torn.
If you have been diagnosed with a rotator cuff injury or you have symptoms that suggest you might have torn your rotator cuff, contact us to discuss your diagnosis and the treatment options most suitable for you.