Rotator Cuff Tear

What are the symptoms of a Rotator Cuff Tear?

• Pain and tenderness
  • The most common complaint is pain around the shoulder, usually around the side or front
  • The pain is especially bad when reaching overhead or behind your back.
    • For example
      • combing your hair
      • hanging up the washing
      • doing up a bra
  • Trouble sleeping
    • The pain can be quite severe and can even affect you at night and disturb your sleep.
• Shoulder weakness
  • You may experience difficulty moving your arm, especially when trying to lift it
  • Many people find it especially hard to lift their arm above shoulder height
• Crackling / Noises when moving the shoulder
  • some people experience crackling noises when moving the shoulder
• Shoulder stiftness
  • You may be restricted in how far your arm can move.

Diagram of the right shoulder
There is a complete full thickness tear of the supraspinatus muscle

• Normal wear and tear. As you get older, your tendons undergo an aging process which makes them more prone to degeneration and injury. The older you get, the more likely you are to have a rotator cuff tear.
• Repetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles causing them to become irritated. This causes inflammation and may eventually lead to a tear in the rotator cuff. This can occur in certain occupations (painters) or certain sporting activities (tennis players)
• Injuries. Falling on your arm can injure your rotator cuff.
• Lifting or pulling. Lifting an object that’s too heavy or doing so improperly — especially overhead — can strain or tear your rotator cuff.

Diagram of the right shoulder
There is a complete full thickness tear of the supraspinatus muscle

What are the risk factors?

• Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
• Certain Sports. Athletes who regularly use repetitive motions, such as tennis players, have a greater risk of having a rotator cuff injury.
• Certain Jobs. Carpenters, painters and other tradesman, who also use repetitive motions, have an increased risk of injury.

Are tests are used in diagnosing rotator cuff tears?

• X-rays. A X-ray of the shoulder will help determine the cause of your shoulder pain.
  • For example,
    • shoulder arthritis,
    • AC joint arthritis
    • Spurs
    • Calcium deposits
• Ultrasound Scan. An ultrasound scan can diagnose rotator cuff tears. It is painless and easy to obtain. However, it can sometimes be inaccurate.
• MRI Scan. A MRI scan is the most accurate test. It can accurately show the size and location of the tear, and help decide if the tear is repairable or not. It can also show other problems in the shoulder such as:
  • AC joint problems
  • Bicep tendon problems
  • Shoulder joint labrum problems

How is a rotator cuff tear diagnosed?

Diagnosis of a rotator cuff tear is based on your symptoms and physical examination.

The best study to diagnose a tear is an MRI, but Xrays and ultrasound can also be very useful.

A Xray of the Left Shoulder showing normal anatomy

• Pain and Disability. A rotator cuff tear should only generally be treated if it is painful and causing trouble. Many people cope well with a rotator cuff tear. However, for some people, an untreated rotator cuff tear can lead to ongoing pain and dysfunction of the shoulder.
• Arthritis. Sometimes a complete tear of the rotator cuff can lead to arthritis of the shoulder joint.

Nonsurgical Options

With proper care, a minor injury to the rotator cuff can often heal on its own.
If you think you’ve injured your rotator cuff, try these steps to help with your pain:

• Rest your shoulder. Stop doing what caused the pain and try to avoid painful movements.
  • For example, stop all activites that involve raising your hand about your shoulders
  • Don’t lift anything heavy
  • Stop contact sports
• Apply ice and heat. Putting ice on your shoulder helps reduce inflammation and pain.
  • Cold packs
    • Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time.
    • Do this every couple of hours the first day or two.
  • Hot packs
    • After about two or three days, when the pain and inflammation have improved, hot packs (used for 20 minutes at a time) may help relax tightened and sore muscles.
• Take pain relieving medications.
  • Paractemol / Ibuprofen
    • Over-the-counter pain relieving medications such as paracetamol or ibuprofen may help reduce pain and inflammation.
    • Remember to follow label directions and stop taking the drugs when the pain improves.
• Exercises. After one or two days of rest, gently start moving your shoulder.
  • Keeping your arm immobilized for prolonged periods can lead to a stiff shoulder.
  • Physiotherapy.
    • After the pain settles down, daily shoulder stretches and a balanced shoulder-strengthening program can help prevent a recurrence of your injury.
    • Most of the time, rotator cuff injuries can be improved by physiotherapy and exercies.
    • A physiotherapist can talk to you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles, and provide balanced shoulder muscle strength.
    • Depending on the severity of your injury, physiotherapy may take several months.

Steroid and Local Anaesthetic injections. An injection of local anaestheitc and corticosteroid injection can relieve your inflammation and pain. Having an injection and physiotherapy is often a very effective way of reducing the pain of rotator cuff tears.

Surgery

If your pain is not improved with rest, exercises, physiotherapy and injections, then surgery may be a good option for you.

Rotator Cuff Repair. A rotator cuff repair is surgery to repairs the torn rotator cuff tendon back into the humerus. During the surgery, the surgeon often removes a inflammed bursa and a bone spur from the acromion (a proceduce called a subacromial decompression). If needed, a surgeon can also perform a:

• Biceps tenodesis or tenotomy
• Shoulder arthroscopy
• AC joint excision

A Rotator Cuff Tear viewed from inside the shoulder joint with a special camera called an Arthroscope

Your Family Doctor (GP)

Your Family Doctor can diagnose and help treat your problem. He or she will be able to

• tell you about your problem
• advise you of the best treatment methods
• prescribe you medications
• and if necessary, refer you to an Orthopaedic Surgeon for further treatment

Trustworthy Resources and Evidence Based Medicine

What you can do in the meantime

Before you appointment with Mr Tran, you can make yourself more comfortable by:

• Resting your shoulder. Avoid movements that aggravatethe pain.
• Pain relievers. Taking pain relieving medications, if necessary. There are Over-the-counter medications, that can be bought without a prescription from a doctor, that can help relieve your pain. These include:
  • Anti-inflammatory medications (called NSAIDs) such as ibuprofen
  • Paracetamol

Unfortunately, rotator cuff disease is often associated with becoming older.

However, you can decrease the chance of having it by:

• Avoiding repetitive overhead activities. Rotator cuff disease is more common in certain sports and occupations.
• Exercises. Do regular shoulder exercises that balance your shoulder muscles.
• Rest your shoulder. Take frequent breaks at work if your job requires repetitive arm and shoulder motions. Rest your shoulder regularly during sports that require repetitive arm use.

Shoulder Exercises. Daily shoulder stretches and a shoulder-strengthening program can help treat and prevent a rotator cuff tear, especially if you’ve had a tear in the past.

It’s especially important to concentrate on all the muscles around your shoulder, as this promotes a balanced shoulder. Most people exercise the front muscles of the chest, shoulder and upper arm, but it is equally important to strengthen the muscles in the back of the shoulder and around the shoulder blade.

A physiotherapist can help you with an exercise routine.

• What is the Rotator Cuff?
• What is a Rotator Cuff Tear?
• What are the causes of a Rotator Cuff Tear?

Research on the Horizon

Many techniques now use dissolvable anchors. These hold stitches in place or hold stitches in bone until the repair has healed. They are gradually absorbed by the body.

Research is also being done on “orthobiologic ” tissue implants. These promote growth of new tissue in the body, and help with the healing process.