A rotator cuff tear is a condition in which part of the rotator cuff tendon gets detached from its attachment onto the top of the arm bone.

Causes

  1. Degenerative: This is the most common type of rotator cuff tear in which the tendon becomes weaker with age and chronic overuse.
  2. Traumatic: Sometimes the rotator cuff can get detached from the bone as a consequence of a trauma in the form of falling onto the shoulder or accompanying a shoulder dislocation.

Symptoms

Most patients complain of pain around the shoulder over the outer aspect of the upper arm. This is made worse on attempting to lift the arm above shoulder level. The pain also disturbs sleep at night.

Weakness

In large rotator cuff tears patients may be unable to lift the arm above shoulder level or experience weakness of the arm while doing any overhead activities.

Diagnosis

The diagnosis is made based on clinical examination. A plain x-ray and an ultrasound or MRI scan are needed to confirm the diagnosis.

Treatment

  1. Steroid Injection & Physiotherapy: In small degenerative rotator cuff tears a subacromial steroid injection and physiotherapy may resolve the symptoms.
  2. Surgical Intervention: Surgical intervention to reattach the torn rotator cuff back to the bone may be needed if non-operative treatment in the form of injections and physiotherapy fail to improve symptoms – in large or traumatic tears where there is significant weakness or loss of function.
    Surgery is usually performed by a keyhole technique (arthroscopic rotator cuff repair). This involves a general anaesthetic. The surgeon inserts a keyhole camera and instruments through a few puncture wounds around the shoulder. The torn rotator cuff is reattached to the top end of the arm bone using sutures and bone anchors.
    Following the surgery the arm will be immobilised in a sling for a period of 4-6 weeks, depending on the size of the rotator cuff tear. Prior to discharge from the hospital you will be seen by a Physiotherapist who will arrange for an outpatient physiotherapy appointment. You are likely to need physiotherapy for up to 3-6 months following surgery to aid your recovery.

Risks & Complications

  • Infection
  • Joint stiffness
  • Tendon re-tear or failure to heal