Rotator Cuff Tears
The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.
Anatomy of the Shoulder
The rotator cuff is a group of four tendons that surround the shoulder joint. Together they initiate movement and provide stability of the humeral head in relation to the glenoid cavity. This enables the arm to elevated in the air and helps maintain strength with activities overhead such as lifting, throwing, swimming, etc. They consist of the subscapularis, supraspinatus, infraspinatus and teres minor. The rotator cuff originates from muscles attached to the scapula and extend laterally to become tendons that attach onto the humeral head.
What is a rotator cuff injury?
An injury to the rotator cuff can range for a minor tear to a complete disruption of all tendons. Tears can be classified as small, medium, large and massive depending on the width of the tear. They are also classified on how far the tendon has retracted from its insertion on the humeral head to its origin on the scapula. Acute tendon tears should be identified early so that appropriate treatment can be initiated. In active patients, repair over rehab may help limit extension of the tear, muscle degeneration and loss of function.
What are the common causes?
Traumatic – This involves a traumatic event (e.g. fall, tackle, direct impact) that leads to an acute disruption of the tendon from its insertion on the humeral head.
Degenerative – These are commonly age-related changes that causes thinning of the tendon over time and can lead to tears in the tendon which may be complete or incomplete.
Impingement lesion – This is where the overlying acromion has a curved or hooked anatomy to it leading to impingement of the tendon as the arm is lifted and overtime damaging the tendon to cause a tear.
Inflammatory/other – Conditions such as rheumatoid arthritis and other inflammatory can cause damage to the overlying tendon which can initiate a tear.
What are the preferred Investigations/Imaging?
Shoulder X-ray – This should be the first imaging modality used as it helps determine if there is any underlying arthritis in the shoulder joint and also if there is an overhanging acromion that may be a cause for impingement.
Ultrasound – This is not as sensitive as an MRI of the shoulder, but in patients where an MRI may be contraindicated it serves as a reasonable imaging choice to help in the diagnosis of tendon tears
MRI – This is the best form of imaging to identify a rotator cuff tear. It helps us isolate which of the tendons is torn, the degree of retraction and the integrity of the muscle. All which help guide our treatment.
What are the treatment options?
Non-operative – This primarily involves a physiotherapy programme centred around strengthening the tendons and muscles which are not injured around the shoulder joint to maintain its range of motion and balance. Appropriate analgesia and modification of the patient’s activities will also need to be considered.
Arthroscopic Rotator Cuff Repair – This involves key hole surgery where the torn tendon is reattached to its footprint on the humeral head via the use of multiple sutures and anchors which secure it to bone.
Tendon Transfer – In cases where the tendon is not repairable (due to its size, degree of retraction or chronicity) or the muscle associated with the tendon is not working, then a tendon transfer can serve as a successful alternative. This procedure involves transferring a tendon from one part of the shoulder girdle to the attachment of the torn tendon. Examples include a lower trapezius transfer for an irreparable supraspinatus or infraspinatus tendon and latissimus dorsi transfer for an irreparable subscapularis tendon.
What does the rehabilitation/recovery involve?
To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.