Rotator Cuff Tear

What is the rotator cuff?.

The rotator cuff is a blending of four tendons that surround the upper arm (humerus). The tendons are attached to bone (humerus) at one end and muscles that are attached to the shoulder blade at the other. The rotator cuff rotates and elevates (lifts) the shoulder, though there are a number of other muscles that help move the shoulder.

How can it be damaged?.

The rotator cuff can be damaged by wear and tear (rubbing on the bony roof of the shoulder) or by sudden injury (such as a fall or dislocation of the shoulder) or by the natural ageing process (degeneration). Most commonly, the supraspinatus tendon is involved but tears can involve the other rotator cuff tendons. As such not all rotator cuff tears are the same and treatments differ.

An intact tendon from within the shoulder.

The same view from within the shoulder, but of a torn tendon.

What problems do patients have?

Rotator cuff tears are not always symptomatic, but pain and weakness of the shoulder can be present. Pain tends to be at the front and side of the shoulder and can radiate to the upper arm (deltoid region). Weakness ranges from mild weakness and pain when lifting objects away from the body to an inability to raise the arm at all in massive tears.

What are the treatment options?

Treatment is individualised based on the type, size and length of time a tear has been present, as well as the level of symptoms a patient experiences. The treatment options are either with or without surgery.

Non-surgery options:

Physiotherapy – aims to strengthen other muscles around the shoulder to “compensate” for the torn tendon.

Injections – help settle the pain in the shoulder and allow patients to undergo a period of physiotherapy.

Arthroscopic (keyhole) debridement and subacromial decompression – aims to make a tear asymptomatic by reducing pain in the shoulder and allowing patients to strengthen the other muscles around the shoulder.

Arthroscopic (keyhole) rotator cuff repair – fixes the tendon back to the bone from where it has torn off. This is achieved by placing anchors, with stitches (suture anchors), into the bone and stitching the tendon back to the bone. Click here for patient information regarding surgery.

Your surgeon will discuss the options and what is right for your treatment.