-Cyprus Orthopaedics

Rotator Cuff Tears

The Rotator cuff is a group of 4 small tendons in the shoulder. A rupture of one or more of these tendons is known as a rotator cuff tear.
Shoulder Procedures-Cyprus Orthopaedics

Rotator Cuff Tears

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, providing stability and allowing for a wide range of motion. When these muscles and tendons become damaged or torn, it can lead to a condition known as a rotator cuff tear. In this article, you will learn about the causes, symptoms, and treatment options for rotator cuff tears.

What is a rotator cuff tear?

A rotator cuff tear is a common injury that occurs when one or more of the tendons in the rotator cuff become torn. This can happen suddenly, such as from a fall or lifting a heavy object, or it can develop over time from repetitive motions or degenerative changes in the shoulder joint. Rotator cuff tears can vary in severity, ranging from a small partial tear to a complete tear of the tendon.

Causes of rotator cuff tears

There are several factors that can increase the risk of developing a rotator cuff tear. One of the most common causes is the natural aging process. As we get older, the tendons in our body become less flexible and more prone to injury. Other causes of rotator cuff tears include repetitive overhead motions, such as those performed by athletes or individuals who engage in activities like swimming or tennis. Traumatic injuries, such as falls or accidents, can also cause a rotator cuff tear.

Types of rotator cuff tears

  • Partial Rotator Cuff Tears: This refers to damage to a portion of the rotator cuff tendon without complete tearing. It’s also known as a partial thickness tear.
  • Complete Rotator Cuff Tear: This occurs when soft tissue tears into two separate pieces, often causing the tendons to detach from the upper arm bone. Full thickness tears typically do not heal independently as muscle action pulls the tear apart. However, partial or full thickness tears can sometimes stabilize, allowing the shoulder to maintain reasonable function and comfort.
  • Acute Tear: These tears result from sudden trauma or injury, such as lifting a heavy object improperly or experiencing a fall with an outstretched arm. Acute tears can also be caused by shoulder injuries like dislocation or a broken collarbone.
  • Degenerative Tear: Many rotator cuff tears develop gradually due to the slow degradation of the tendon, often with various underlying causes. Factors such as genetics, certain health conditions like high cholesterol and diabetes, and repetitive stress on the dominant arm increase the likelihood of a degenerative tear. Furthermore, natural degeneration with age raises the risk of injury over time.

Symptoms of rotator cuff tears

The symptoms of a rotator cuff tear can vary depending on the severity of the tear. Common symptoms include pain, weakness, and a decreased range of motion in the affected shoulder. You may also experience difficulty lifting objects or performing activities that require overhead motion. In some cases, a rotator cuff tear may cause a popping or clicking sensation in the shoulder joint. If you are experiencing any of these symptoms, it is important to seek medical attention for an accurate diagnosis and appropriate treatment.

Diagnosing a rotator cuff tear

To diagnose a rotator cuff tear, your doctor will perform a physical examination and may order imaging tests, such as an MRI or ultrasound. During the physical examination, your doctor will assess your range of motion, strength, and perform specific tests to evaluate the integrity of the rotator cuff. Imaging tests can provide detailed images of the shoulder joint, allowing your doctor to determine the size and location of the tear.

Non-surgical treatment options for rotator cuff tears

In many cases, non-surgical treatment options can effectively manage the symptoms of a rotator cuff tear. These may include rest, and over-the-counter pain medications to reduce pain and inflammation. Physical therapy exercises can help strengthen the muscles around the shoulder joint and improve range of motion. In some cases, your doctor may recommend corticosteroid injections to reduce pain and inflammation. However, it is important to note that these treatments may not be effective for larger or more severe tears.

Surgical treatment options for rotator cuff tears

If non-surgical treatments do not provide sufficient relief or if the tear is severe, surgical intervention may be necessary. The goal of surgery is to repair the torn tendon and restore function to the shoulder joint.  There are several surgical techniques that can be used to repair a rotator cuff tear, including open repair, arthroscopic repair, and mini-open repair. Your doctor will determine the most appropriate surgical approach based on the size and location of the tear, as well as your overall health and activity level.

Rehabilitation and recovery after rotator cuff surgery

Following rotator cuff surgery, rehabilitation is a crucial part of the recovery process. Physical therapy exercises will be prescribed to gradually restore strength and range of motion in the shoulder. It is important to follow your physical therapist’s instructions and attend all scheduled therapy sessions to optimize your recovery. Recovery times can vary depending on the severity of the tear and the type of surgery performed, but most individuals can expect a full recovery within 4 to 6 months.

Preventing rotator cuff tears

While it may not be possible to completely eliminate the risk of developing a rotator cuff tear, there are steps you can take to reduce your risk. It is important to maintain good posture and use proper lifting techniques to avoid putting unnecessary strain on the shoulder joint. Regular exercise to strengthen the muscles around the shoulder can also help prevent injury. If you participate in activities that involve repetitive overhead motions, such as sports or manual labor, be sure to take regular breaks and listen to your body’s signals of fatigue or pain.

The majority of rotator cuff tears do not heal naturally. Asymptomatic tears are not uncommon in the general population over the age of 50 years. There is good evidence to suggest that over time a substantial proportion of tears will enlarge albeit gradually and become symptomatic. 

Healthy tendons rarely tear. A rotator cuff tear may result from wear and tear in the tendon or sometimes as a result of an injury such as a fall. In individuals over the age of 40 rotator cuff tears can occur as a result of dislocation of the shoulder.

The condition usually commences with a gradual onset of pain in the shoulder. A diagnosis of Rotator cuff tear is made based on the history of a painful shoulder and/or weakness. Pain is usually intermittent and experienced when reaching overhead or when lying on the shoulder at night. The arm may tire more easily with activity. Individuals may find it difficult to raise the arm above the shoulder. A tear should be suspected if weakness develops in the shoulder after an injury. Examination shows pain with certain movements of the shoulder and weakness on special rotator cuff tests. An X-ray is essential to look at the shape of the acromion and the rest of the joint. An ultrasound scan may confirm the diagnosis. Special imaging with an MRI scans is sometimes necessary to obtain further information about the location and size of the rotator cuff tear, the state of the joint and the muscles of the rotator cuff.

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication. 

Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific exercises to maintain movements, overcome stiffness and improve the function of the healthy part of the rotator cuff. Exercises to improve the strength of the deltoid can improve overall function of the shoulder.

Steroid injection: A steroid injection placed accurately into the subacromial space will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. Repeated injections are not advisable as there is a possibility of the condition of the tendon deteriorating. For further information on steroid injection in the shoulder click here.

Surgery: If symptoms are troublesome and persist despite nonoperative treatment, it may be appropriate to undertake surgical treatment.  This consists of arthroscopic or “key-hole” surgery to repair the torn tendon and decompress the subacromial space by shaving some bone from the undersurface of the acromion. Following surgery symptoms will usually settle over a period of time. Full recovery may take 6-12 months.

For further information on surgical treatment, please refer to the procedures section.

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