Rotator Cuff Tear

The rotator cuff tendons are comprised of four tendons deep in the shoulder joint that stabilize as well as move the shoulder and arm. Rotator cuff tears are common in older individuals, and is usually due to wear and tear and impaired healing.

One can also sustain a rotator cuff tear from a traumatic injury to the shoulder.

Degenerative rotator cuff tears develop over time and are usually due to an imbalance between daily wear and tear and healing. The symptoms may vary, with many patients not having any symptoms at all. More than half of individuals over the age of 70 years will have an asymptomatic rotator cuff tear.

When symptomatic, one may experience pain or weakness in the shoulder, which may impair shoulder function. The pain may occur when trying to raise the arm, or even when lying down and sleeping. Weakness in the shoulder may manifest as the inability to raise the arm.

The severity of rotator cuff tears may vary. Minor tears may affect half the thickness or half the width of the tendon. More severe tears may result in the entire tendon being disconnected from its bony attachment, or detachment of more than one tendon.

It is possible for small tears to progress in size to become larger with time.

Symptoms from partial tears are usually amenable to treatment with physiotherapy and pain control. Lifestyle modifications may also be required. Larger tears may result in some permanent weakness in the shoulder.

Physiotherapy can help to decrease pain and improve shoulder function. On rare occasions, steroid injections may help manage the pain. Steroids however may affect the tendon integrity and may predispose the tendon to further tearing.

Symptomatic tears or large tears may be successfully treated with surgical repair of the tendons. This can either be done via a keyhole operation, or via a small incision in the side of the shoulder. The aim of the surgical repair is to reattach the tendon to the bone from which it is torn.

The body then needs to heal the tendon to the bone. This may require up to 6 weeks of protection in an armsling as well as several months of physiotherapy thereafter to improve the shoulder function.

Tendon tears that are old and large may result in the attached muscle degenerating and scarring up. This may render the tendon tear irreparable even with surgery. Shoulders with very old tears may also develop pain and arthritis with time.

If one is very symptomatic from such a tear, other salvage operations may help to relieve the symptoms and hopefully improve the shoulder function. This may be in the form of partial tendon repairs, the insertion of subacromial balloon spacers, superior capsule reconstruction, or even shoulder joint replacement.
Every individual’s tear is different, and the best course of treatment is usually tailored to each individual and their symptoms and functional requirements. It is best to consult and to be assessed by a shoulder surgeon to manage this problem.

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