Rotator Cuff Injury

The rotator cuff is a group of muscles which help control, stabilise and function the shoulder joint. It is made up of four muscles: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. These muscles close to the shoulder joint, lying deep to the larger muscles you see in your chest, shoulder and arm.


Rotator Cuff Injury: Causes

Rotator cuff tearing is one of the most common problems occurring within the adult shoulder, especially in older and active people. Tearing to the rotator cuff can be symptomatic (painful) or asymptomatic (not painful).

The exact nature of rotator cuff tears can be hard to determine, although the broad types of tearing to the rotator cuff are traumatic (acute injury) or attritional (wear and tear). Attritional type tears are the most common, and become more common as people get older.

In traumatic tears, an injury causes separation of the attachment of the tendon from it’s insertion to the bone of the shoulder (humerus). These tears may be associated with a dislocation of the shoulder in adults or other high energy injuries. They are often large tears, and frequently require surgical repair.

Attritional tears occur more slowly in a gradual fashion. The tendon insertion gradually tears away from the humerus, eventually leading to a full thickness tear. These tears tend to progress more slowly, although they can progress more rapidly with the addition of a new injury (acute on chronic tear). Attritional tears do not always cause pain in the initial stages, although frequently pain can develop with time.

Rotator Cuff Injury: Symptoms

People with symptomatic rotator cuff tears can present with a variety of symptoms. Most commonly, patients will describe pain around the shoulder region, which can be difficult to localise. Patients will frequently have difficulty with overhead activities, reaching behind their back, working at arms length and sleeping on the affected side.

Rotator Cuff Injury: Diagnosis

Rotator cuff tearing can be diagnosed after an appropriate history and physical examination with later diagnostic imaging. Examination generally reveals weakness of the rotator cuff musculature (weak shoulder movements) and pain on raising the arm above the head. Further imaging is used to confirm the diagnosis, most commonly an MRI or ultrasound scan.

Rotator Cuff Injury: Treatment

Treatment of rotator cuff tears involves both non-surgical (conservative) and surgical management depending on the exact nature of the tear and the patient presenting with it. When tears are small and pain is minimal with a chronic tear, an initial attempt at non-surgical management may be attempted. This will often involve an injection to the shoulder with some physical therapy. In these circumstances, the tear will not heal itself, but patients may be able to function well without repair of the tendon.

Surgical Treatment:

In traumatic rotator cuff tears, larger rotator cuff tears or where more conservative management has failed, your surgeon may recommend repair of the rotator cuff tendon to restore functionality to the rotator cuff. The torn tendon is re-attached to the bone, and a sling is used for some time after surgery to allow the tendon to heal. I prefer to use arthroscopic techniques (keyhole surgery) for rotator cuff repair, enabling the surgery to be completed via smaller incisions equating to less post-operative pain and a faster recovery. Complete recovery from rotator cuff repair can take 3-6 months, although long-term outcomes are positive, with a high satisfaction rate amongst patients.

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