Tears of the rotator cuff are a common cause of shoulder pain and occur with increasing frequency as patients age. The rotator cuff consists of four muscles with tendons that surround the top part of the shoulder joint. These four muscles are called:
- Teres minor
Their function is to assist in lifting the arm forward and sideways. The majority of tears in the rotator cuff are within the supraspinatus tendon, but more extensive tears also can involve the other tendons.
Causes of Rotator Cuff Tears
Rotator cuff tears are very uncommon in people under the age of 40 and they become increasingly frequent in people around the age of 70 to 80. The most frequent cause of the tear is age related degeneration. A fall onto the point of a shoulder, or onto an outstretched hand can also cause a tear. This condition is also more frequently seen in people who repetitively use their arm above head height, and this would include tradesmen and sports people, such as plasterers, painters, tennis players or swimmers.
Pain in the shoulder region is the predominant symptom. This pain often radiates into the upper arm. It can commence gradually or suddenly after unaccustomed activity or an injury. The pain may be more noticeable at night and may be associated with a feeling of weakness in the arm.
The diagnosis of rotator cuff tear is based on the patient’s history, clinical examination and special tests which include x-rays, ultrasound and MRI scan. It is important that x-rays be performed as they may demonstrate an acromial spur. These spurs may cause an impingement syndrome and the spur may rub against the supraspinatus tendon causing it to tear prematurely.
Ultrasounds are a relatively inexpensive way of demonstrating whether there is a tear within the rotator cuff, however they are dependant on the expertise of the ultrasonographer. For this reason, many ultrasounds are not accurate.
The MRI scan is the state of the art investigation for rotator cuff tears, and can demonstrate whether the tear is partial or full thickness. This may also indicate whether the tear is surgically repairable.
In many cases patients may be treated conservatively. Conservative options include:
- Rest and modification of activities
- Simple pain killers and anti-inflammatory medication
- Steroid injection around the rotator cuff tendons
- Strengthening exercises
It is worth noting that many patients have rotator cuff tears without any symptoms. In many patients, symptoms will settle spontaneously over several months, particularly with the above measures.