Rotator Cuff Tears
A rotator cuff tear occurs when one or more of the tendons in the shoulder’s rotator cuff are partially or fully torn. These tears can result from injury, repetitive strain, or age-related wear and tear. They often cause pain, weakness, and reduced shoulder movement, which can affect daily activities and quality of life.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
The Rotator Cuff
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, helping to stabilise the upper arm bone (humerus) in the shoulder socket and allowing a wide range of movement. The four muscles are:
- Supraspinatus: Runs along the top of the shoulder, lifting the arm out to the side.
- Infraspinatus: Located at the back of the shoulder, responsible for outward rotation of the arm.
- Teres minor: A smaller muscle next to the infraspinatus, also helps rotate the arm outward.
- Subscapularis: Found at the front of the shoulder, rotates the arm inward.
The tendons of these muscles converge to form a cuff around the head of the humerus. Damage to any of these tendons is called a rotator cuff tear. Tears can be partial, where only some fibers are damaged, or full-thickness, where the tendon is completely torn from the bone.
Understanding Rotator Cuff Tears
A rotator cuff tear can cause a range of symptoms, which may develop gradually or suddenly depending on the cause. Common signs include:
- Shoulder pain: Often felt at the front or side of the shoulder, which can worsen at night or with overhead movements.
- Weakness: Difficulty lifting or rotating the arm, or performing everyday tasks like reaching or combing hair.
- Limited range of motion: Reduced ability to move the arm in certain directions.
- Clicking or popping sensations: Some people notice sounds when moving the shoulder.
- Swelling or tenderness: Around the front or top of the shoulder in some cases.
Pain and weakness may make it hard to carry out normal daily activities, and symptoms can fluctuate, sometimes improving temporarily and then returning.
Causes & Risk Factors
Rotator cuff tears can occur due to a combination of wear and tear, injury, and individual factors:
| Age-related degeneration | Tendons naturally weaken with age, making tears more likely. People over 40 are at higher risk, even without specific injuries. |
| Repetitive overhead activities | Sports like tennis, swimming, or occupations involving frequent overhead lifting can strain the tendons over time. |
| Acute injury | A fall onto an outstretched arm, a sudden jerk, or lifting something heavy incorrectly can cause a tear. |
| Poor Blood Supply | Reduced circulation to the tendons, which can occur naturally with age or in people with certain health conditions, can impair healing and increase the risk of tears. |
| Bone Spurs | Bony growths on the shoulder, often related to age or long-term tendon wear, can rub against the tendons and cause gradual damage. People with arthritis or chronic shoulder impingement are more prone. |
| Medical Conditions | Diabetes or other systemic health issues can make tendons more susceptible to injury and slower to heal. |
Diagnosing Rotator Cuff Tears
Diagnosing a rotator cuff tear begins with a clinical assessment. A healthcare provider will review your symptoms and examine your shoulder, checking for pain, weakness, reduced range of motion, and any visible changes in contour or muscle bulk. They will also test how your shoulder moves and whether certain positions trigger pain or weakness.
Imaging is often used to confirm the diagnosis and assess the extent of the tear:
| Ultrasound | Can identify tears, tendon thickness, and fluid around the tendons. It also allows dynamic assessment, observing tendon movement in real time. |
| MRI | Provides detailed images of the tendons, muscles, and surrounding structures. It is particularly useful for larger or complex tears and for surgical planning. |
| X-Ray | While they don’t show tendons directly, they may be used to rule out other shoulder problems, such as arthritis or bone spurs. |
Treatment Options
Treatment depends on the size of the tear, the level of pain or functional limitation, and your overall health. Many tears can be managed without surgery, while others may require surgical repair.
Conservative Treatments
| Rest and activity modification | Avoiding activities that worsen pain while keeping gentle movement to prevent stiffness. |
| Physiotherapy | Exercises to strengthen surrounding muscles, improve shoulder stability, and maintain range of motion. |
| Pain relief | Over-the-counter painkillers or anti-inflammatory medications can help manage discomfort. |
| Steroid injection | Steroid injections may reduce inflammation and provide temporary pain relief in selected cases. |
Surgical Management
Surgery may be considered if pain persists, function is limited, or the tear is large or worsening. Options include:
| Arthroscopic repair | Minimally invasive surgery to reattach torn tendons. |
| Open repair | A larger incision may be needed for more complex tears. |
| Tendon transfer or shoulder replacement | Rarely, used for massive tears or severe joint damage. |
Recovery can take several months, and post-surgery rehabilitation is essential for regaining strength and mobility. Your healthcare provider will discuss which treatment options are most suitable for your situation.
How can Lanthorn help?
Shoulder Ultrasound - £300
This non-invasive imaging technique uses sound waves to create a real-time picture of your shoulder tendons. It allows clinicians to see tears, inflammation, or other tendon changes and can be repeated over time to monitor.
Ultrasound-guided Steroid Injection - £450
A steroid injection can be delivered directly into the affected area under ultrasound guidance. This helps reduce inflammation, relieve pain, and improve function, often allowing participation in physiotherapy or rehabilitation exercises.
Shoulder MRI - £350
provides a highly detailed view of the shoulder, showing the rotator cuff tendons, muscles, and surrounding tissues. This helps to confirm the size and severity of a tear, identify any associated injuries, and guide decisions about surgery.
