Shoulder Pain

Rotator cuff injuries

What are Rotator Cuff injuries?

Rotator cuff muscles are underneath the bigger deltoid muscle group, deep in the shoulder. A cuff tear means that that tendon has detached from its attachment to the arm bone (humerus) either fully or partially. As shown in the picture above the cuff tears could range from very minimal tears to complete full thickness tears.

  • Partial thickness tear: In this type the tendon does not get fully severed and only part of the tendon is torn.
  • Full thickness Tear: This is a full tear where the tendon is split into two pieces. In most cases the tendon tears off where it attaches to the head of the humerus and there is usually a hole in the tendon close to the insertion.

What causes rotator cuff tears?

Trauma (acute)

  • Falling on outstretched arm. 
  • Lifting something heavy with a sudden jerking or twisting motion at the shoulder.
  • This trauma can accompany other shoulder injuries including a broken collar bone or arm bone (humeral head).

Degenerative tears (Chronic) As a part of the aging process there may be some fraying at the tendon from repeated use. Many factors contribute to these degenerative tears:

  • Repeated stress may lead to slow degeneration of the tendon.
  • Lack of proper blood supply: as we get older the blood supply to those tendons may be reduced. This could lead to tears in the cuff tendons.
  • Bony spurs could develop under the acromion leading to impingement and damage to the tendon.

What are the symptoms of Cuff tears?

  • Pain at rest and at night especially when sleeping on the affected side.
  • Pain and difficulty with reaching or over head movements as well as lifting.
  • Inability or weakness in lifting and lowering your arm
  • Crepitus or cracking sound when moving the shoulder in different directions.

How can you treat the problem?

This varies vastly depending on the severity. Minor tears (usually less than 3 cm) are not recommended for surgery unless the patient is involved in high impact contact sport.

Treatment would include gentle active exercises to the shoulders and the use of anti-inflammatories and pain killers.

What Other Treatments are available?

If symptoms fail to respond you may need to be assessed by a specialist to discuss a further course of treatment.

Surgical treatment could be recommended if you satisfy the following criteria:

  • Your symptoms have lasted 6 to 12 months
  • You have a large tear (more than 3 cm)
  • You have significant weakness and loss of function in your shoulder
  • Your tear was caused by a recent, acute injury.