Rotator Cuff Tear Video
What is a rotator cuff tear?
The shoulder is surrounded by a powerful inner layer of muscles called the rotator cuff. They help to move your shoulder by keeping the ball of the shoulder joint (humerus) in the middle of its socket (glenoid). The muscles are connected to the arm bone (the humerus) via tendons. A rotator cuff tear happens when these tendons tear away from the bone.
Not everybody experiences symptoms even if they do have a cuff tear because there are other muscles around the shoulder that are still working. The problems that people typically experience include pain at the front and top of their shoulder when reaching up or out. It can make it difficult to perform usual daily activities such as washing your hair and reaching into high shelves. It can also affect your sleep because many people cannot lie on the affected side.
Larger tears can result in weakness when trying to lift the shoulder and some people even need to use their other arm to lift up the affected arm. Occasionally, after many years, this condition can lead to a type of arthritis called cuff tear arthropathy.
Who gets rotator cuff tears?
The rotator cuff tendons can wear out and tear over time. In fact, half of people who are over 60 have a partial tendon tear, and one in four have a full-thickness tear.
Sometimes, middle-aged people can suffer a sudden tear of their tendon after a major injury such as a shoulder dislocation or a heavy fall.
How is a rotator cuff tear diagnosed?
This starts with a conversation with your doctor to describe the problems you are experiencing with your shoulder. You will then be examined, with some specialised tests that test the strength of the rotator cuff muscles. Usually, you will have an X-ray which can give clues about whether there is a cuff tear and sometimes what has caused it. You will then have an ultrasound or MRI scan to look for the tear.
What are the treatment options?
Rotator cuff tears can be treated in several ways:
- Take simple painkillers and change your lifestyle
- Physiotherapy
- Steroid injection
- Surgery
Remember, one in four people over 60 have a full-thickness rotator cuff tear. Few of these people notice any problem with their shoulder. The primary aim of treatment is to relieve your symptoms, and that does not always require a surgical repair.
Simple painkillers and change of lifestyle
For some people, just knowing what the problem is, and what activities to avoid, is enough. The pain can be controlled with simple painkillers, such as paracetamol and anti-inflammatories (if you can take them). This may be coupled with simple changes to your lifestyle, such as sleeping on the opposite side or putting heavy items on lower shelves at home.
Physiotherapy
A course of physiotherapy is very effective for rotator cuff tears. Your physiotherapist will assess your movements and teach you ways of moving your shoulder without experiencing the pain. They will show you exercises to strengthen the muscles around your shoulder that are not torn and can compensate for the tear. It can take several months to get the full benefit of physiotherapy, so it is important to work hard early on, even if you do not feel an immediate benefit.
Steroid injection
You may be offered a steroid injection into your shoulder. This is sometimes referred to as a cortisone injection. The purpose of this injection is to settle down any painful inflammation in your shoulder. This is a very effective treatment, especially when coupled with physiotherapy. By taking the pain away, even temporarily, it can make it easier to do the exercises given to you by your physiotherapist. There are several rare risks of steroid injections:
- Allergic reaction: This is very rare, but can be life-threatening.
- Infection: This is rare, but can result in severe pain 1-2 weeks after the injection and may require surgery to wash out the injection.
- Change in the colour or texture of your skin where it is injected. This is very uncommon and more pronounced in people with darker skin colours.
- Steroid ‘flare’: This can result in a temporary worsening of pain from 1-3 days after the injection.
Read more about steroid injections here.
Will I need surgery for a rotator cuff tear?
Torn rotator cuff tendons do not heal by themselves. However, with physiotherapy and injections, many people notice a significant improvement in their symptoms. Although you may be left with some minor problems with your shoulder, they may not be severe enough for you to contemplate surgery. In fact, even surgery does not guarantee to return your shoulder to normal.
Over time, there is 50% chance of a smaller tear becoming larger. You may not even notice this, but it sometimes leads to worsening pain or weakness. If this happens, you may wish to consider surgical treatment. If you develop a very large tear, your shoulder may lose a lot of strength to the point that you cannot raise your arm at all. This may also progress to painful arthritis. In this situation, it might not be advisable, or even possible, to surgically repair your rotator cuff and you may instead be offered a shoulder replacement.
Surgery
If the above treatments are not successful, surgery may be helpful to treat a rotator cuff tear. This is usually performed ‘keyhole’ and is often referred to as an arthroscopic rotator cuff repair. Click here to find out more about what this type of surgery involves.