This condition is where the shoulder becomes painful and difficult to use. The pains felt in the upper arm and is made worse by lifting the arm up especially above the head. The pain is often particularly bad at night.
In this condition the small tendons around the shoulder are torn. These tendons are very important for normal function of the shoulder. There are 4 of these tendons and together they are called ‘The rotator cuff.’
These tendons do tend to wear as people move through life, and a tear can be normal, but if they tear in the active person it can cause significant difficulties.
A tear may happen without injury and purely due to wear and tear, these are degenerative tears. Or a tear may happen due to an injury and these are traumatic tears.
The diagnosis is made on a combination of the patient’s story (history), how the shoulder moves (examination) and the tests (investigations) performed.
The most common way to look at the rotator cuff is with an ultrasound scan, which can give information about the state of these tendons. If an ultrasound scan is done it is important to have an X-ray as well, because an X-ray will show any wear of the shoulder joint itself.
The other common investigation used is an MRI (magnet) scan. In certain situations this can give more information.
Painkillers: Are very important to help manage the pain associated with rotator cuff tears.
Physiotherapy: Can help improve the function of a shoulder with a rotator cuff tear. I can be used in isolation with to give good results or it can be used after injections and surgery.
Injections: An injection of cortisone (a steroid) into the tissue around the tendon can help control the pain associated with rotator cuff tears. The injection can be given in the clinic or can sometimes be combined with an ultrasound scan and be given in the X-ray department. It is important though that repeated injections are avoided because this can weaken the remaining tendons.
Arthroscopic surgery: Key hole surgery is often used to repair rotator cuff tendons (arthroscopic rotator cuff repair). It does take a bit of time to get over, but in the correct person can give very good results.