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The rotator cuff is a collection of four muscles that arise from the shoulder blade (scapula). The tendons that form around these muscles are attached around the margin of the ball-shaped humeral head. The job of the rotator cuff is to help hold the humeral head against its socket while the arm is moving.
If the rotator cuff is not working properly, this can lead to weakness of the affected shoulder; in severe cases, it may be difficult to lift the arm up at all. Pain is also common in rotator cuff problems. The pain may be directly due to tendon injury, or it may be a result of the shoulder moving incorrectly and irritating other structures nearby. In cases where a tear has been present for a long time, the altered alignment of the shoulder can lead to a pattern of shoulder arthritis called rotator cuff tear arthropathy.
The thick rotator cuff tendons are made up of many tiny fibres which attach to the humerus bone over a wide “footprint”. If some of the fibres fail the tendon will become thinner, even though it is still intact overall. This thinning of the tendon is called a partial thickness tear. If all the fibres have failed in one area this creates a hole in the tendon, which is a full thickness tear.
Rotator cuff tears can be the result of gradual wear and tear over time (degenerative tears). They can also be the result of an acute accident, such a fall, dislocation or a wrenching injury to the shoulder. It is also possible to have a small degenerate tear that suddenly gets bigger following an injury.
Rotator cuff tears do not always cause symptoms. Partial thickness tears are more common with age, and because they happen slowly over time the body is able to adapt to their presence. A small full thickness tear may also not cause any symptoms at all. There may also be other issues causing pain in the shoulder, such as AC joint arthritis.
In the early stage of rotator cuff disease, pain can be managed with simple analgesia (“painkillers”) and rest. Physiotherapy can help to rebalance the shoulder by improving the strength and coordination of the weakened shoulder muscles. In some cases, a steroid injection will help get the pain under control so that you can perform the physiotherapy exercises.
Surgery may be required in cases where the shoulder has not responded to appropriate non-operative treatment. In this procedure, the torn tendon is attached to the bone (rotator cuff repair) and any bone spurs or inflamed tissue is removed from around the tendon (subacromial decompression). If the tendon or the muscle behind it is not healthy enough to repair then decompression alone, or with partial repair, it may still provide excellent pain relief. In some cases, a salvage procedure such a tendon transfer or a superior capsular reconstruction may be required. For large tears in older patients, a reverse total shoulder replacement may be the best treatment.
The decision about how to treat a rotator cuff tear involves considering several factors, such as the size of the tear, the quality of the surrounding muscles, the degree of symptoms, your activity level or work demands, and age.
At the Melbourne Shoulder and Elbow Centre, our surgeons are highly experienced in the assessment and management of rotator cuff tears. They will help you choose the best treatment for you based on your unique set of circumstances.
