|►Rotator cuff tear|
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|►Advice sheet on injection|
|►Advice sheet on decompression|
|►Advice sheet on stabilization|
|►Advice sheet on cuff repair|
Rotator cuff tear
The presentation of a rotator cuff tear is often similar to that of a subacromial impingement; however the pain is often more severe. In addition there is normally a degree of weakness of the shoulder and in some cases virtually all active shoulder movement is lost.
In younger patients a rotator cuff tear is often the result of trauma such as a fall. In older patients however the tear more frequently develops spontaneously due to 'wear and tear.'
The rotator cuff forms the socket in which the humeral head is located (see Shoulder anatomy). When the cuff tears the mechanics of the joint are severely affected since there is no longer a stable fulcrum around which the shoulder can rotate; in some cases this will lead to a complete inability to elevate the arm, but somewhat surprisingly many patients suffer only minor loss of function.
If subjected to sufficient force (e.g. in a fall) even a normal rotator cuff will tear; this is the normal cause of a tear in a younger patient. In older patients the rotator cuff tends to fail as part of the 'wear and tear' process of ageing.
The diagnosis of a cuff tear can often be made clinically:
- Wasting of the shoulder girdle muscles, especially the infraspinatus
- Weakness of the shoulder, particularly of external rotation (infraspinatus)
- Loss of active elevation of the arm
- Passive (assisted) movement is often of normal range
Plain radiographs may show a reduction in the distance between the humeral head and the overlying acromium. The tear can be definitively confirmed by an MR or ultrasound scan.
A variety of treatments is available for patients with a rotator cuff tear and it should be noted that surgical repair will not always be indicated.
In a young patient with a traumatic tear of the cuff who has lost function in the shoulder surgical repair of the cuff will normally be the treatment of choice. Surgery will normally relieve pain, although function may never return to normal.
In a patient with a degenerate cuff tear however surgical repair may not be the best option; it must be remembered that a degenerate tendon has limited repair capabilities and therefore may not heal after surgery. In theses cases management as outlined for the treatment of subacromial impingement is often the best option. In the elderly patient who has lost all shoulder function a shoulder replacement may be considered.
|© J M Britton 2007|