What is rotator cuff tear?

The rotator cuff is a group of muscles which wrap closely around the shoulder joint. They function to keep the joint in the correct position and control shoulder and arm movements. The muscles attach from the shoulder blade to the top of the arm bone by the rotator cuff tendons. These tendons can be damaged through ‘wear and tear’ or after an accident or fall. Damage to one or more of these tendons can lead to shoulder and arm pain and weakness.

What causes the condition?

It’s a common injury, especially in sports like tennis or golf, or in jobs like painting or cleaning windows. It usually happens over time from normal ‘wear and tear’, or if you repeat the same arm motion over and over. However, it also can happen suddenly if you fall on your arm or lift something heavy.

What are the typical signs?

• Pain at rest and at night, particularly if lying on the affected shoulder
• Pain when lifting and lowering your arm, in particular, when movement above shoulder height is painful and difficult e.g. reaching into a high kitchen cupboard
• Weakness when lifting or rotating your arm
• Crepitus or crackling sensation when moving your shoulder in certain positions.

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, to assess your range of motion and check for any additional problems like a pinched nerve. This may be followed by an X-ray to determine if there are any other issues such as osteoarthritis, and in all cases, an ultrasound or MRI scan to show the extent of the tear.

Non-surgical treatment: Painkillers and anti-inflammatory medication may help to reduce the pain. Physiotherapy can sometimes be helpful in improving shoulder strength, and reduce the pain and weakness. This is particularly effective if the tear is as a result of ‘wear and tear’ and may have been present for many months (chronic tear). However, for an acute tear following an accident, fall or injury we advise urgent assessment of your shoulder, and prompt treatment of acute tears is likely to result in the best outcome for your shoulder and arm function.

Surgery: If the rotator cuff tendons are torn, you will need an operation to repair them back onto the arm bone. This aims to reduce pain and to restore arm and shoulder function. If the tear is due to ‘wear and tear’, you are likely to need additional treatment to prevent further rubbing of the tendon and recurrence. This will be performed at the same time as your surgery to repair the tear. Surgery to repair the rotator cuff is carried out by a keyhole (arthroscopic) procedure and is most often performed as a day-case operation (you come into hospital on the morning of surgery and go home on the same day).

Recovery

This depends on the type of treatment you’ve had, but can take from between 4 and 12 weeks if you’ve had surgery. Your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around four weeks post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months
• Driving – Will depend on the extent of the tendon tear and repair, but will be a minimum of three weeks
• Exercise – Will depend on the extent of the tendon repair, usually commencing at the five week post-op mark