#condition - Shoulder
Rotator Cuff Tear
- A functional rotator cuff is important in maintaining normal shoulder function
- Tears of the cuff tendons can cause pain, weakness and functional limitation
- An accurate diagnosis usually requires imaging of the shoulder (ultrasound / MRI)
- Treatment depends on a number of factors including the type and size of the tear
The rotator cuff is made up of the four tendons that connect the muscles of the shoulder blade (scapula) to the upper arm bone (humerus). These help control the movements of the ball and socket joint of the shoulder. The four tendons are supraspinatus, infraspinatus, subscapularis and teres minor.
Tears can occur in tendons weakened by age, inflammation, disease, trauma, daily wear and tear, and repetitive strain. Tears can also occur in younger people, following sudden, high-energy trauma. The tendons most commonly tear at their insertions (where the tendon joins the muscle to the bone).
Magnetic resonance imaging (MRI) studies of patients without symptoms, over the age of 60 years, suggest that tears may be present in around 50% of this population. Full thickness tears make up approximately half of these and partial thickness tears the remainder. MRI scanning is only 75-95% accurate in diagnosing rotator cuff tears, so the true number of degenerate tears of the rotator cuff in the population is unclear.
Tears of the rotator cuff range from a partial tear in one tendon, to complete tears in one or more of the tendons. In partial tears, only some tendon fibres are torn resulting in weakness of the tendon. This can cause significant discomfort, but there may not be too much loss in arm movement. However, over time, partial tears can worsen. Further disruption of the remaining tendon fibres may occur, producing a full-thickness tear. A larger tear usually results in more weakness and pain. Depending on its location, a full thickness tear can lead to a complete rupture of the tendon, as the tendon completely tears off the bone.
Your surgeon will usually be able to diagnose the presence of rotator cuff damage on the basis of your symptoms and an examination. This may need to be supplemented by an ultrasound or MRI scan in order to define the site, extent and nature of the tear. Further imaging can also help to assess whether a tear can be repaired. Often a final assessment is only possible at the time of surgery, where a diagnostic assessment is performed using keyhole surgery.
Partial under surface tears will heal in approximately 10%. A further 10% will decrease in size and 80% enlarge to become full thickness. 50% of patients with an tear, but no symptoms, will become symptomatic over a five-year period. Full thickness tears are likely to cause symptoms.
A complete tear will not heal by itself. In these cases, surgery is the only means of repairing a tear. The aim is to improve shoulder function and comfort by repairing any tears in the tendon and if necessary reattaching the tendon to bone.
During the consultation with your surgeon, you will have the scans reviewed in the context of your situation. From this there will be an assessment as to how repairable the complete (full thickness tear) is and whether it can be repaired, or needs reconstructing. The aim of surgical treatment is to improve shoulder function and comfort. Repairing the tendon means reattaching the tendon to the bone, while reconstructing means adding a patch graft between the end of the tendon and the bone.
Physiotherapy is usually needed in conjunction with surgical repair or reconstruction. A tailored rehabilitation programme helps with pain relief and also helps patients maintain and regain function.
The success of surgical treatment depends on the size, thickness and location of the tear and the quality and amount of remaining normal tendon tissue. Early treatment is generally preferred, as the outcome of surgery is often worse when a tendon has been torn for some time.