The shoulder joint is a ball and socket type joint, where the humerus (upper arm bone), the ‘ball’, articulates with the scapula (shoulder blade), the ‘socket’. The rotator cuff is a group of four muscles and tendons that surround the shoulder joint. These muscles allow the shoulder to move in different directions and importantly they provide stability to the joint. The rotator cuff tendons all attach to the head of the humerus.
There are two types of tears that can occur in the rotator cuff. These are partial and full thickness tears. Partial tears occur in the tendon and can be visualized as fraying of the intact tendon. With a full thickness tear the tendon can be visualized as having a tear through the tendon that can be as small as a pin hole or as large as a 50-cent piece.
Rotator cuff tears can occur acutely through injury, such as a fall onto an outstretched arm and may also be chronic in nature whereby the tendons are exposed to repeated stress through repetitive movements of the shoulder such as overhead activities or lifting.
The most common symptoms of a rotator cuff tear are a painful shoulder either at rest or with activity and weakness with arm movements to shoulder height and above. However a rotator cuff tear can be asymptomatic.
Treatment of rotator cuff repairs is through conservative (non-operative) and operative management. Conservative management of the tear consists of avoidance of aggravating activities (such as work overhead or heavy lifting), the use of anti-inflammatory medications, steroid injection into the shoulder and physiotherapy to strengthen the rotator cuff and increase scapula control.
Surgical repair of the rotator cuff can be performed arthroscopically (‘key hole’) or through an open repair (incision is made and a muscle is moved out of the way to access the torn tendon). Open repairs are usually performed on large or complex tears of the rotator cuff.
Post operative physiotherapy is essential to maximising the outcome after surgical repair of a rotator cuff tear.