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Rotator cuff tear

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 5 minutes read
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A rotator cuff tear refers to a tear of one of the tendons of the rotator cuff. The rotator cuff tendons of the shoulder are a set of tendons responsible for the movement of the shoulder in different directions. A rotator cuff tear is a common cause of shoulder pain and is typically associated with weakness in certain shoulder movements.

Rotator cuff tears are a common cause of shoulder pain and become more common with increasing age. Rotator cuff tears in younger people are most likely the result of a specific injury, whereas rotator cuff tears in older people are typically the result of longstanding tendon degeneration.

The rotator cuff

The rotator cuff muscles are a collection of four muscles around the shoulder; supraspinatus, infraspinatus, teres minor and subscapularis. These muscles function to move the shoulder in different directions and help to stabilise the shoulder joint.

The supraspinatus tendon is the most common site of a rotator cuff tear. The muscles of the rotator cuff have tendons that surround the shoulder joint. A rotator cuff tear refers to a tear in one or more of these tendons.

There are two main types of rotator cuff tear:

  • an acute traumatic rotator cuff tear: these are tendon tears that occur following a specific injury to the shoulder
  • a chronic degenerative rotator cuff tear: these are tendon tears that do not have a specific associated injury

A chronic degenerative rotator cuff tear has a number of factors that can contribute to its development, however, in most cases, they occur as a result of the normal wear and tear that accompanies ageing. In fact, rotator cuff tears are often found in people without any shoulder pain. It is poorly understood why some rotator cuff tears can go unnoticed whilst others can cause significant symptoms. Symptomatic rotator cuff tears that are left untreated can result in wear and tear of the shoulder joint itself, otherwise known as rotator cuff tear arthritis.

Rotator cuff tear vs other conditions

Shoulder impingement syndrome

Shoulder impingement syndrome, or subacromial impingement, occurs when the rotator cuff tendons or bursa become pinched or compressed between the bones of the shoulder joint (acromion, humeral head) during overhead movements. Causes may include repetitive overhead activities, poor posture, or anatomical variations. Symptoms typically include shoulder pain, especially with overhead movements or reaching, weakness, and limited range of motion. Pain may be worse at night or with certain activities. Diagnosis is based on clinical evaluation, imaging studies (e.g., X-rays, MRI), and sometimes diagnostic injections to assess the source of pain and inflammation. Treatment often involves conservative measures such as rest, activity modification, physical therapy to strengthen the rotator cuff and improve posture, anti-inflammatory medications, and corticosteroid injections. In some cases, surgical intervention may be necessary to address structural abnormalities contributing to impingement.

Bursitis of the shoulder

Shoulder bursitis involves inflammation of the bursa, fluid-filled sacs that cushion and lubricate the shoulder joint. It can result from overuse, trauma, repetitive overhead activities, or underlying conditions such as rotator cuff tears or impingement. Symptoms include shoulder pain, tenderness, swelling, and warmth around the affected area. Pain may worsen with movement or pressure on the shoulder. Diagnosis is based on clinical evaluation, imaging studies (e.g., ultrasound, MRI), and sometimes diagnostic injections to confirm the presence of bursitis and rule out other conditions. Treatment typically involves conservative measures such as rest, ice, anti-inflammatory medications, physical therapy to improve shoulder mechanics and reduce inflammation, and corticosteroid injections. In some cases, aspiration of fluid from the bursa may be necessary to relieve pain and swelling.

Frozen shoulder (adhesive capsulitis)

Adhesive capsulitis is characterised by inflammation and thickening of the capsule surrounding the shoulder joint, leading to stiffness and restricted range of motion. The exact cause is unknown, but risk factors may include trauma, prolonged immobilisation, diabetes, or thyroid disorders (hyper or hypothyroidism). Symptoms typically include gradual onset of shoulder pain, stiffness, and progressive loss of range of motion, often in a capsular pattern (external rotation, abduction, internal rotation). Diagnosis is based on clinical evaluation, imaging studies (e.g., X-rays, MRI), and ruling out other shoulder conditions that may mimic adhesive capsulitis. Treatment focuses on pain relief, preserving range of motion, and improving shoulder function. Conservative measures may include physical therapy, stretching exercises, anti-inflammatory medications, and corticosteroid injections. In some cases, manipulation under anaesthesia or surgical release of the capsule may be considered for persistent symptoms.

When to see your doctor?

If you develop severe shoulder pain and weakness following an injury you should seek medical attention sooner. If your shoulder pain has come on very quickly or is associated with you feeling unwell, especially with a fever, you should seek urgent medical attention.

What will your doctor do?

Your doctor will ask you about your symptoms and examine you. On occasions you may require further imaging to assess the shoulder joint, this could be an X-Ray and/or an MRI scan. If a diagnosis of rotator cuff tear is made you may be given advice regarding exercises to help relieve your symptoms and improve the function of your shoulder. You may be referred to a physiotherapist in the first instance, depending upon the local services available.

If your symptoms fail to improve despite physiotherapy input or are very severe, you may be referred to an orthopaedic surgeon. Additional hospital treatments that can be offered for rotator cuff tears include injections, surgery to repair the rotator cuff or joint replacement surgery if the rotator cuff tear is associated with shoulder arthritis.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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