Rotator Cuff Tears

When the tear is caused by an accident (typically after a fall), the person feels a sharp pain, sometimes with a crackling sensation inside the joint. Almost immediately it becomes difficult to move the shoulder normally.

In fact, pain is the main symptom of a rotator cuff tear, and is mainly felt when the joint is used, but can also wake the person up at night. Pain can set in later in cases where the tear occurs due to wear and tear.

In all cases there is muscle weakness or the muscles get fatigued easily, in particular during repeated upwards motions of the arm.

The origin of the injury can be:

• traumatic (a hit or fall on the shoulder region, excessive loading),
• degenerative (due to wear or overloading),
• mixed (in some cases, these two factors both contribute).

It is often difficult to determine which of these factors had the greatest influence over the development of the tear.

In older patients, one wrong movement during a harmless activity like hanging up washing or lifting a bag of shopping can be enough.

Even though partial tears are common over the age of 50, full tears are rare before the age of 60 (around less than 10% even in older patients), and affect the supraspinatus tendon in 85% of cases. Accidental tears mainly affect young patients under the age of 50, and often occur during contact sports such as ice hockey, rugby, and snowboarding.

There are many morphological (shape of the shoulder blade or humerus), genetic, and environmental (including diabetes, high cholesterol, smoking, and alcoholism) risk factors.

After a tear, mobility can return on its own over the course of several weeks, but most commonly the pain felt in the shoulder area persists.

Rest is prescribed first, alongside physiotherapy sessions, painkillers, and anti-inflammatories. This conservative therapy has two objectives: to reduce pain and restore enough mobility in the shoulder for rehabilitation to take place. In addition, it can be useful to apply hot and cold compresses. These measures are sufficient for a lot of patients. This conservative option is best suited to cases of a partial tear, in older patients, and as long as conservative treatment provides results. It is contraindicated in young, active patients who have a large tear, particularly if the cause is clearly an injury.

If conservative treatment fails, i.e. if there is no improvement after several months, surgery may be required. The decision to operate depends on various factors. In addition to the severity of the tear, the intensity of the pain, and the impact on the joint's mobility, the patient's age, motivation, level of physical activity, and occupation are taken into account.

There are several different surgical options. If the tendons can be repaired, an arthroscopy*A surgical technique used for various operations that only makes a few small incisions and uses a small camera. Considered to be minimally invasive, this technique has few complications and enables patients to return to sport quickly. of the rotator cuff is proposed. If tendon repair is contraindicated or impossible, either palliative (tendon transfer) or prosthetic techniques will then be evaluated.

Tears rarely heal on their own. Even when shoulder mobility is well or quite well preserved, pain tends to persist along with some degree of mobility loss in some cases.

The normal medical advice in terms of a healthy lifestyle also apply to preventing rotator cuff tears:

• doing a suitable form of activity on a regular basis,
• eating a healthy diet,
• avoiding tobacco and alcohol.

It is important not to smoke before a rotator cuff operation and during the subsequent rehabilitation period because tobacco has a negative impact on the healing process and the final result.

If you experience debilitating pain for over two months that is not solved with the conservative treatment mentioned above then you should talk to your family doctor.

The first step is a clinical examination that will be carried out by a sports physician or a shoulder surgeon. If they suspect a tear, a conventional X-ray and an ultrasound will also be done. Magnetic resonance imaging (MRI) will only be required if the diagnosis is in doubt or if needed before an operation.