Rotator Cuff Tears and Inflammation

A Common Cause of Shoulder Pain, Weakness and Limited Movement

Your rotator cuff is a group of four muscles and tendons that help stabilise your shoulder and allow for a wide range of movements. When one or more of these tendons is torn, you may experience pain, weakness, and difficulty with activities that require lifting your arm or rotating your shoulder. Rotator cuff tears are common, especially as we age, or for those involved in repetitive overhead activities.

CAUSES OF ROTATOR CUFF TEARS

Rotator cuff tears can result from a variety of causes, and understanding them can help you avoid or manage these injuries:

Degeneration (Wear and Tear): As we age, the blood supply to the rotator cuff tends to decrease, making it more vulnerable to wear and tear. Degenerative tears often occur slowly over time and are more common in individuals over 40. Even normal daily activities, such as lifting objects or reaching overhead, can contribute to this wear.
Acute Injury: A sudden force, such as falling on an outstretched arm or lifting something too heavy, can cause a rotator cuff tendon to tear. This type of injury is often associated with immediate pain and weakness in the shoulder, and is more likely to require urgent treatment.
Repetitive Overuse: People who engage in activities that involve repetitive shoulder movements are at higher risk of developing rotator cuff tears. Athletes who play sports like tennis, baseball, or swimming, as well as individuals with jobs that involve overhead work (such as painting or carpentry), are particularly prone to these injuries over time.
Bone Spurs: As part of the ageing process, bone spurs (small bony projections) can form on the acromion, the bone above your shoulder joint. These spurs can irritate or pinch the rotator cuff tendons, leading to a tear over time, a condition known as shoulder impingement.

SYMPTOMS OF A ROTATOR CUFF TEAR

The symptoms of a rotator cuff tear can vary depending on the severity of the injury. In many cases, these tears can develop gradually, making the symptoms easy to overlook at first.

Key symptoms include:

Pain: Pain is often felt in the front or side of your shoulder and can worsen with certain movements, particularly lifting or lowering your arm. It may also be more noticeable at night, especially when lying on the affected shoulder.
Weakness: You may notice that your shoulder feels weaker when trying to lift objects, particularly above shoulder height. This weakness can make it difficult to perform tasks that involve raising your arm or reaching behind your back.
Loss of Motion: A rotator cuff tear can reduce the range of motion in your shoulder. You may feel stiff or notice difficulty reaching overhead or behind you. The shoulder may also feel “stuck” or “locked” in certain positions.
Clicking or Popping: You might hear or feel clicking, popping, or crackling sounds when moving your shoulder. This can be a sign that the torn tendon is catching or rubbing against other parts of the shoulder joint.
Recurrent Shoulder Pain: Rotator cuff tears often result in chronic shoulder pain that comes and goes. This pain can flare up during certain activities or become persistent, affecting your overall quality of life.

DIAGNOSIS OF ROTATOR CUFF TEARS

When you meet with Dr Liddell, he will carefully assess your shoulder’s function and ask about your symptoms, medical history, and any activities that may have contributed to the injury. A thorough physical examination will help determine the extent of weakness and loss of motion in your shoulder.

Dr Liddell may also recommend the following diagnostic tools to confirm the presence and severity of a rotator cuff tear:

X-Rays: Although X-rays cannot show soft tissue like tendons, they can help identify other issues, such as bone spurs, that may be contributing to shoulder pain.
Ultrasound: An ultrasound can be used to assess the condition of the rotator cuff tendons in real time. It allows Dr Liddell to observe the tendons as you move your shoulder and detect any tears or abnormalities.
MRI (Magnetic Resonance Imaging): An MRI is often the preferred imaging tool for diagnosing rotator cuff tears, as it provides detailed images of both the tendons and muscles in the shoulder. This scan can also reveal the size and location of the tear, as well as the condition of the surrounding tissues.

ROTATOR CUFF TEAR TREATMENT OPTIONS

Treatment for rotator cuff tears depends on the severity of the tear, the level of pain or weakness, and how much the injury affects daily activities. Many people respond well to non-surgical treatment, especially for partial tears or inflammation. Options may include:

Activity Modification: Avoiding overhead movements, lifting, or repetitive shoulder use can help reduce symptoms and prevent further strain on the injured tendon.
Physiotherapy and Rehabilitation: A personalised exercise program to strengthen the shoulder muscles, improve range of motion, and restore function is often the first line of treatment.
Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and swelling associated with tendon irritation or inflammation.
Corticosteroid Injections: An injection into the shoulder may be considered to reduce inflammation and provide short-term pain relief, particularly if symptoms are interfering with sleep or mobility.

If the tear is large, full-thickness, or not improving with non-operative care, surgery may be recommended:

Rotator Cuff Repair Surgery: The torn tendon is reattached to the bone, often using arthroscopic techniques. Surgery aims to restore strength and stability to the shoulder.
Shoulder Debridement or Subacromial Decompression: In cases of inflammation or impingement, removing inflamed tissue or smoothing the bone surface can help reduce irritation to the rotator cuff.
Post-Surgical Rehabilitation: After surgery, a structured physiotherapy plan is essential to protect the repair, restore movement, and rebuild shoulder strength gradually over time.