Rotator cuff tears refer to injury to the tendons of the rotator cuff muscles. The tendon may be partially or fully torn.
Tears of the rotator cuff can occur due to an acute injury (e.g., a fall onto an outstretched hand) or degenerative changes with age. They may be related to overhead activities, such as playing tennis or overhead construction work.
Basic Anatomy
The rotator cuff is made of four muscles, each with a specific action at the shoulder (mnemonic is SITS):
- S – Supraspinatus – abducts the arm
- I – Infraspinatus – externally rotates the arm
- T – Teres minor – externally rotates the arm
- S – Subscapularis – internally rotates the arm
Presentation
Rotator cuff tears may present either with an acute onset of symptoms after an acute injury, or with a gradual onset of symptoms. Patients typically present with:
- Shoulder pain
- Weakness and pain with specific movements relating to the site of the tear (e.g., abduction with a supraspinatus tear)
Patients may find it difficult to get comfortable at night due to pain in the shoulder, disrupting sleep.
Investigations
X-rays will not show soft tissue injuries such as rotator cuff tears. They may be helpful for excluding bony pathology, such as osteoarthritis.
Ultrasound or MRI scans can diagnose a rotator cuff tear.
Management
Patients with degenerative rotator cuff tears may be managed conservatively, particularly where they are at increased risk of complications from surgery. Active or young patients and those with acute or full-thickness tears are more likely to be managed with surgery. Surgery may be used where physiotherapy fails.
Non-surgical options are:
- Rest and adapted activities
- Analgesia (e.g., NSAIDs)
- Physiotherapy
There are many options for surgical management, depending on individual factors. The main option is arthroscopic rotator cuff repair, where the tendon is reattached to the bone during an arthroscopy (keyhole surgery).
Last updated August 2021