What is a Rotator Cuff Tear?

A rotator cuff tear is merely a tear within your shoulder’s rotator cuff tendons. A rotator cuff tear can occur in two ways:

• trauma, and
• repeated microtrauma.

Traumatic rotator cuff tears occur quickly or under heavy load, e.g. a fall or lifting a heavyweight. However, the most common cause of a rotator cuff tear is repeated microtrauma, which can occur over several weeks, months or years.

Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft tissue resulting in bruising or swelling. Since only a few millimetres are separating your rotator cuff tendons from a bony hood (acromion), the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons.

What are the Symptoms of a Rotator Cuff Tear?

Your rotator cuff tears may be partial or full-thickness tears. You will notice that your shoulder pain and weakness increase with the severity of your rotator cuff tear. More importantly, it is the reduction in your shoulder function.

Partial rotator cuff tear may only present with mild shoulder pain, clicking during shoulder elevation, and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back.

Full-thickness rotator cuff tear will typically present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases, the rotator cuff tear is so severe that a significant number of your pain fibres are torn, which can make them less painful but very weak.

When you have a small rotator cuff tear, you can often still raise your arm with or without pain. Moderate tears are usually very painful, and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a massive rotator cuff tear occurs, you may find that you cannot lift your arm at all.

What is the Rotator Cuff?

Your shoulder’s rotator cuff is a group of four small shoulder muscles that stabilise, control and move your shoulder joint. The four muscles collectively known as the rotator cuff are your subscapularis, supraspinatus, infraspinatus and teres minor muscles. When your rotator cuff muscles work in isolation, they exhibit rotational motion at the glenohumeral (shoulder) joint, which we describe as the rotator cuff.

How is a Rotator Cuff Tear Diagnosed?

Your physiotherapist or sports doctor will suspect a rotator cuff tear based on your clinical history and the findings from a series of clinical tests.

A diagnostic ultrasound scan is the most accurate method to diagnose the size and location of your rotator cuff tear. MRIs may show a rotator cuff tear but have also missed a tear. X-rays are of little diagnostic value when a rotator cuff tear is suspected.

Please consult your trusted shoulder physiotherapist or doctor for specific advice regarding your rotator cuff tear.

What about Corticosteroid Injections?

Corticosteroid injections may relieve pain and promote tendon healing. Cortisone’s primary function is to increase blood sugar, suppress your immune system, and aid in fat, protein and carbohydrate metabolism.

There are side effects, and corticosteroid injections should be used cautiously, especially with diabetics. It also decreases bone formation and leaves you vulnerable to future tendon rupture.

Researchers generally find an excellent short-term benefit from corticosteroids, but some long-term side effects may be less desirable. Some patients report good initial relief before a recurrence of symptoms. As with all medications, please discuss the pros and cons of corticosteroid injection with your doctor.

Rotator Cuff Repair Surgery

An option is rotator cuff repair surgery for full-thickness and partial-thickness tears that do not heal with physiotherapy. Most shoulder surgeons will recommend at least six weeks of physiotherapy before contemplating rotator cuff repair surgery.

Post-operative physiotherapy rehabilitation is comprehensive and regular for your best outcome. Your post-operative rotator cuff repair recovery commonly takes between six to twelve months.

During rotator cuff repair surgery, your surgeon will attempt to sew your torn tendon back together. The best results occur when the tear is fresh rather than older damage.

Most rotator cuff repairs take approximately six months of rehabilitation to regain as complete as possible range of motion, shoulder strength and function.

It is essential to follow your physiotherapist’s exercise prescription and the surgeon’s post-operative advice. In our experience, about 90% have an excellent outcome at 12 months postoperatively.

As with all surgery, there are associated risks or complications. These can include infection, stiffness, blood clot formation, and nerve injury. The dangers of significant joint stiffness are less than 5%, and the risk of nerve injury is low – approximately 1 in 10000.

Shoulder Replacement Surgery

Using a routine rotator cuff repair, some massive rotator cuff tears will be irreparable. In these instances, a total shoulder replacement is an option for you and your surgeon.

Please seek your trusted shoulder physiotherapist or doctor for their specific advice.

Shoulder Pain FAQs & Products