Rotator Cuff Tears
What Is the Anatomy of the Rotator Cuff That Maintains Stability?
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. Together, they attach the humeral head (upper arm bone) to the shoulder blade (scapula) and help stabilise the ball of the humerus within the shallow socket of the glenoid. The rotator cuff allows smooth movement of the shoulder while maintaining joint stability during activities such as lifting, reaching, or throwing.
How Does the Rotator Cuff Tear?
Rotator cuff tears can occur due to acute trauma or gradual wear and tear.
Traumatic tears often occur after a fall, heavy lifting, shoulder dislocations, or a sudden jerking motion of the arm.
Degenerative tears develop gradually with age or repetitive overhead use, leading to tendon thinning and fraying.
Tears can range from partial thickness (incomplete tear) to full thickness (complete detachment of the tendon from the bone).
What Is the Long-Term Consequence of Having a Rotator Cuff Tear?
If left untreated, a rotator cuff tear can lead to:
Persistent pain and weakness, especially with overhead or lifting activities.
Progressive enlargement of the tear and muscle atrophy.
Fatty degeneration of the rotator cuff muscles, which may make later repair more difficult.
Loss of shoulder function and reduced range of motion.
Development of cuff tear arthropathy, a type of arthritis caused by long-standing tendon deficiency.
How Does a Rotator Cuff Tear Get Diagnosed?
Diagnosis is based on clinical history, examination, and imaging:
History of shoulder pain, weakness, or night pain, especially when lying on the affected side.
Physical examination to assess range of motion, strength, and specific tendon function.
X-rays to evaluate bone spurs or changes in the shoulder joint.
Ultrasound or MRI to visualise the tear, measure its size, and assess the quality of the surrounding tissue.
What Are the Indications for Treating Rotator Cuff Tears Non-Operatively?
Non-operative management is appropriate in the following situations:
Small or partial-thickness tears.
Older or low-demand patients with minimal symptoms.
Patients with significant medical comorbidities making surgery risky.
Chronic degenerative tears with minimal functional loss.
Patients preferring to avoid surgery.
Treatment focuses on physiotherapy to strengthen the surrounding muscles, improve range of motion, and reduce pain. Other measures include anti-inflammatory medication, corticosteroid injections, and activity modification.
What Are the Indications for Treating Rotator Cuff Tears Operatively?
Surgery is indicated in the following cases:
Full-thickness tears in active or younger patients.
Acute traumatic tears with significant loss of strength or function.
Persistent pain and weakness despite adequate non-operative treatment of degenerative tears.
Failure of non-operative management of partial thickness tears
Surgical options include arthroscopic or open repair of the torn tendon, often reattaching it to the bone using anchors. In cases of large or irreparable tears, tendon transfers or reverse total shoulder replacement may be considered depending on patient age, function, and tissue quality.
