The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bones (see Anatomy). The strength of the cuff allows the muscles to lift and rotate the humerus (the bone of the upper arm).

The tendons run under the acromion (part of the shoulder blade) where they are very vulnerable to being damaged. A tear may result suddenly from a single traumatic event or develop gradually. The pain is also very common at night, often radiating down the arm.

As people age, it is normal for the rotator cuff tendon to wear and degrade, however only a small proportion of people develop pain and weakness that requires treatment.

Causes:

1. Injury, especially while trying to lift or catch a heavy object
2. Overuse, especially after a period of inactivity
3. Poor blood supply to an area of the cuff (which occurs with increasing age)
4. A fall on an outstretched arm
5. A gradual weakening of the tendons of the shoulder, often associated with impingement

Diagnosis:

A rotator cuff tear is best disgnosed with a scan.

1. Ultrasound Scan
2. MRI Scan

We use both ultrasound and also MRI scans if we need information on the muscle quality (required for some surgical procedures)

Prevention:

1. Avoid excessive overhead activities.
2. Strengthen your shoulders and do not try to play or work through the pain

Treatment:

1. Painkillers and anti-inflammatory medications
2. Physiotherapy – keeps your shoulder strong and flexible and reduce the pain and weakness
3. Cortisone steroid injections – reduces inflammation and control the pain
4. Surgery is required
   1. If the tear follows an injury
   2. When pain and weakness is not improved with injections and physiotherapy

The goal of any surgery is to relieve the pain and improve the shoulder strength. This requires a long period of physiotherapy in addition to the surgery.

Surgery may be done Arthroscopically (keyhole) or Open, or a combination of the two, know as a Mini-repair.

Some tears are too large to repair and are known as ‘Massive Cuff Tears'