ROTATOR CUFF TEAR

Rotator cuff tear

The rotator cuff is an important group of muscles and tendons that stabilises the shoulder joint and allows the arm to move. It consists of four muscles: the supraspinatus, the infraspinatus, the subscapularis and the teres minor. These muscles surround the shoulder joint like a cuff – hence the name – and make movements such as lifting, rotating and stabilising the arm possible.

Injury to or wear of the rotator cuff is common, particularly in athletes (in tennis, swimming and throwing sports, for example), in people who work with their hands, and in people from middle age onwards through degenerative processes. A rotator cuff tear can be partial or complete and needs specialist treatment.

The team at Sportklinik Freiburg has many years of experience in diagnosing and treating rotator cuff injuries and offers both non-surgical and surgical treatment.

What is the rotator cuff?

Definition

The rotator cuff is an important group of muscles and tendons that stabilises the shoulder joint and allows the arm to move. It consists of four muscles:

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

These muscles surround the shoulder joint like a cuff – hence the name – and make movements such as lifting, rotating and stabilising the arm possible.

Common conditions and injuries

Injury to or wear of the rotator cuff is common, particularly in:

Athletes (in tennis, swimming and throwing sports, for example)
People who work with their hands
People from middle age onwards, through degenerative processes

Typical conditions:

Rotator cuff tear (a partial or complete tear of the tendon)
Tendinopathy (irritation of the tendon)
Impingement syndrome (the tendon being pinched beneath the acromion)
Calcific tendinitis (tendinosis calcarea)

How serious is it?

Damage to the rotator cuff can lead to considerable loss of shoulder function. Left untreated, rotator cuff tears can lead to chronic instability and progressive deterioration of the shoulder. In active people and athletes in particular, an early diagnosis and early treatment are decisive for long-term success.

Important: acute shoulder pain after a fall or an injury should always be assessed promptly.

Potential for healing

The potential for healing depends on the size of the tear, the age of the patient and how long the symptoms have been present. Smaller tears can heal with non-surgical treatment, while larger tears often need surgical repair. With an early diagnosis and appropriate treatment the outlook is good in most cases.

Symptoms

Damage to the rotator cuff typically shows itself through characteristic symptoms, which can differ with the extent of the injury.

Pain

Pain when raising the arm above shoulder height, particularly with overhead movements

Pain at night

Pain at night, occurring particularly when lying on the affected side

Loss of strength

Loss of strength in the arm and restricted movement of the shoulder

Diagnostics

A suspected rotator cuff tear is investigated systematically, combining several examination methods in order to arrive at a precise diagnosis and plan the best treatment.

Clinical examination

The clinical examination is the first step towards the diagnosis. Specific tests are used to assess the function of the rotator cuff and to locate the pain.

X-ray

X-rays show changes in the bone, such as calcium deposits or arthritic changes in the shoulder joint.

MRI (magnetic resonance imaging)

MRI is the most important imaging method for assessing the tendons and muscles of the rotator cuff. It shows tears, degenerative changes and accompanying problems.

CT (computed tomography)

If an MRI scan is not possible, a CT scan can be carried out to assess the bony structures and their relationship to the soft tissues.

Ultrasound of the shoulder

Ultrasound is generally used after an operation, to follow the course of healing and to pick up possible complications early.

Treatment options

Treatment of a rotator cuff tear depends on the size of the tear, the age of the patient, how active they are and their individual symptoms. With an early diagnosis and appropriate treatment the outlook is good in most cases.

Non-surgical treatment: with partial tears or where the tendon is irritated, non-surgical treatment can be successful.

Surgical treatment: for a tear caused by an accident, a complete tear, or where non-surgical measures have not worked.

Treatment options

Non-surgical and surgical – we will find the right approach for you

Non-surgical

Physiotherapy

To strengthen the shoulder muscles and improve movement

Non-surgical

Pain management

Medication and physical treatment to relieve the symptoms

Non-surgical

Injections

With a corticosteroid or hyaluronic acid, to reduce inflammation and relieve pain

Non-surgical

Adjusting the load

Adjusting the load in everyday life and sport to protect the injured structures

Surgical

Arthroscopic repair

Arthroscopic repair of the tendon or tendons using modern suture techniques

Surgical

Tendon transfer

Tendon transfer or a joint replacement where the damage is advanced

Aftercare

The aftercare following rotator cuff surgery is decisive for the long-term success of the treatment.

The arm rests in an abduction pillow for 6 weeks
Full load only after 3 months
Movement is built up step by step under the guidance of a physiotherapist
Complete healing in 3 to 6 months, depending on the findings

Consistent aftercare and avoiding overloading during the healing phase are particularly important.

Outlook

With an early diagnosis and appropriate treatment the outlook is good in most cases. Consistent aftercare and avoiding overloading during the healing phase are particularly important.

A return to sport is generally possible after 6 to 12 months, depending on the extent of the injury and the treatment chosen.

Frequently asked questions about rotator cuff tears

What is a rotator cuff tear?

A rotator cuff tear means a tear of the tendons of the rotator cuff, a group of four muscles in the shoulder. These muscles provide the stability and the movement of the shoulder. A tear can arise through overloading, a sudden injury or age-related wear, and leads to pain, restricted movement and weakness in the arm.

How does a rotator cuff tear arise?

The most common cause of a rotator cuff tear is repeated overloading, particularly in activities that involve raising the arm above the head, such as tennis or swimming. Injuries such as a fall onto the arm can also cause a tear. With age the tendon tissue becomes weaker, which increases the likelihood of injury.

What are the symptoms of a rotator cuff tear?

Typical symptoms are pain in the shoulder, particularly with overhead movements or when raising the arm. People affected often also report weakness in the arm, which makes lifting or rotating it harder. Restricted movement and pain at night can occur as well, and affect quality of life.

How is a rotator cuff tear diagnosed?

The diagnosis begins with a thorough clinical examination, in which the doctor tests the movement and stability of the shoulder. To establish the extent of the tear, an MRI scan or ultrasound is generally used. These imaging methods allow the damage to be assessed precisely.

How is a rotator cuff tear treated?

Depending on the severity of the tear, treatment can be non-surgical or surgical. With smaller tears or moderate symptoms, rest, pain medication and physiotherapy are used first. If the tear is large, however, or shoulder function is considerably affected, an operation may become necessary. The tendon is then repaired either arthroscopically (minimally invasively) or through open surgery.

When is an operation necessary?

An operation is usually recommended where the tear is large, the shoulder is markedly weakened, or non-surgical treatment is not sufficient. This applies in particular to patients who depend on full shoulder function, such as athletes, or in work that regularly involves overhead movements.

What can I do to prevent a rotator cuff tear?

As a precaution you should do regular exercises to strengthen the shoulder muscles and avoid overloading. Good technique in sport and warming up before physical activity can also help to reduce the risk of a rotator cuff tear.

Can I be fully active again after a rotator cuff tear?

With the right treatment and rehabilitation, most patients can return to their normal activities. It can take some time before the shoulder is fully functional again, however, and in some cases the loads placed on it need to be adjusted.

What happens if a rotator cuff tear is left untreated?

Left untreated, a rotator cuff tear can lead to chronic pain and long-term restrictions. Over time the shoulder can deteriorate further, which can lead to permanent loss of function or even to osteoarthritis. Early treatment is therefore important.

Our shoulder specialist

Experienced consultants for rotator cuff tears and shoulder surgery

Dr. med. Ralph Mayer

Consultant in Orthopaedics, specialist orthopaedic surgery