Rotator cuff tear

The shoulder is a ball and socket joint. The rotator cuff is a group of muscles and tendons which function to keep the ball in the socket. They also help you raise and rotate your arm. These tendons can be damaged through wear and tear or after an accident or fall. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the ball of the shoulder and can cause pain and weakness.

Pain is often felt over the point of the shoulder and upper arm or in the upper arm. Patients experience pain at rest and at night, particularly if lying on the affected shoulder. There is pain when lifting and lowering the arm or with specific movements. There can be weakness when lifting or rotating the arm. There is sometimes a crackling sensation when moving your shoulder in certain positions.

A rotator cuff tear is usually diagnosed by a specialist after taking a history and performing a clinical examination. An x-ray of the shoulder and an ultrasound scan are usually needed to confirm the diagnosis and occasionally an MRI is needed.

Yes. Not all rotator cuff tears need surgical repair. Most rotator cuff tears are degenerative tears and are a result of wear and tear in the tendon which is a natural phenomenon of ageing. Approximately 30% of people aged over 70 have a rotator cuff tear that doesn’t cause any symptoms.

Do avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head (such as swimming or playing tennis) for a few days or weeks. Ask a GP or physiotherapist when you can restart these activities.

Do take painkillers – anti-inflammatory painkillers (such as ibuprofen) or paracetamol may help. A GP can prescribe stronger painkillers if needed.

Do hold an ice pack (or a bag of ice cubes or frozen vegetables) to your shoulder for around 20 minutes several times a day – but do not put it directly on your skin. Wrap it in a towel first.

Don’t stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It’s usually best to avoid using a sling.

Rest, pain killers and avoiding activities that cause pain help the shoulder recover. Physiotherapy can be helpful in improving shoulder strength and reducing pain and weakness. An anti-inflammatory steroid injection into shoulder can help to reduce inflammation and pain. These treatments are useful when treating a degenerative rotator cuff tear. The disadvantage of treating degenerative rotator cuff tears in this way is that the size of the tear can increase in time and activities may have to be limited as strength is unlikely to return to normal. Surgery may be necessary if these treatments fail.

For an acute rotator cuff tear following an accident, fall or injury surgical repair of the tendon is often advised. Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the ball of the shoulder joint. The aim of surgery is to reduce pain and improve the function of the shoulder.

Arthroscopic (keyhole) rotator cuff repair is a day-case procedure performed under a regional anaesthetic nerve block which numbs the whole arm. The patient is awake for the duration of the procedure which enables them to go home sooner after surgery. Painkillers will be prescribed for when the nerve block wears off. The arm will be in a sling for 6 weeks before exercises are allowed to start. The patient visits their GP 10 days after surgery for removal of stitches and regular physiotherapy visits are booked. Mr Wijeratna sees patients in clinic 3 months after surgery and discharges the majority of patients at that point.