Pathophysiology

The rotator cuff is a group of 4 muscles which control shoulder stability and rotational movements. Rotator cuff tears are often present with no symptoms with 40-50% of those aged over 60 having a rotator cuff tear but 70% of these having no pain or symptoms.

During normal aging the rotator cuff will degenerate and may then be unable to meet the demands asked of it. It is not the tear itself that causes the pain but the altered biomechanics and therefore irritation as a result. Tears can either be traumatic (from an accident) or degenerative (from normal ageing). Evidence suggests there is no difference between outcomes of surgical intervention compared to physiotherapy treatment.

Symptoms

• Pain generally at the front of the shoulder which can radiate to the biceps region
• Can be after an accident- may be bruising
• May be unable to lift the arm by itself, but with support may be able to move
• Pain and difficulty in tasks e.g. putting on coat, reaching behind your back or brushing hair
• Being unable to lie on the shoulder
• Often no pain with full thickness tears but problems with movement or function

Management

• Activity modification
• Ice or heat
• Pain relief
• Physiotherapy- to include range of movement exercises, stability exercises and a gradual strengthening programme

Investigations

• In traumatic cases may be referred to orthopaedics for investigations including imaging and sometimes surgical repair