Introduction
The rotator cuff is a group of four muscles that contribute to shoulder movement and stability. The four muscles are subscapularis, supraspinatus, infraspinatus and teres minor. They insert into the bone as tendons.
Tears of the rotator cuff most commonly occur in the supraspinatus tendon. They may be full thickness or partial thickness tears.
With age, the incidence of thinning or tearing of the rotator cuff increases. Approximately 30% of people between 60-69 suffer from tear and this increases to 62% in those over 80.
Causes
Most rotator cuff tears are degenerative - as a result of age-related thinning of the tendon and repetitive use.
In some cases, it is caused by a specific injury, such as a fall, a work injury, a sports injury or a motor vehicle accident.
Signs and Symptoms
Diagnosis is based on patient signs, symptoms and imaging tests.
Pain
Shoulder pain is typically dull and may radiate down the arm. Pain at night is common. They pain is typically worse with overhead activity (such as when reaching for high objects)
Weakness
This is another common feature. Over a period of time, the arm may get weaker.
Stiffness
Some stiffness may occur.
Activity Limitation
One may have difficulty performing activities requiring shoulder movement. For example:
- Reaching for cupboards / clothesline.
- Washing hair.
- Brushing teeth.
- Doing / Undoing bra.
- Sports requiring overhead motion / throwing.
Tests
X-ray
X-rays may show bone spurs suggestive of cuff tear or may reveal other causes of shoulder pain such as arthritis.
Ultrasound
Ultrasound can diagnose tears of the rotator cuff including location and size of the tear.
MRI
MRI provides more sophisticated examination of the tear, including the size, the amount of atrophy of the muscle and quality of the tendon.
Non-surgical treatment
Most people with symptomatic rotator cuff tears do not require surgery.
Rest
This means avoiding activities that aggravate / cause pain.
Pain killers and Anti-Inflammatory Medications
Steroid Injections have an anti-inflammatory effect and may settle the pain associated with the tear.
Physiotherapy
This is aimed at maintaining and improving motion and strength of the shoulder.