What is the condition?

The rotator cuff is a group of muscles and tendons that stabilise the shoulder and help with lifting and rotation. A tear occurs when one or more of these tendons is damaged, either from injury or wear and tear over time.

 

What are the symptoms?

· Pain in the shoulder, especially when lifting or reaching overhead

· Weakness or reduced shoulder strength

· Difficulty sleeping on the affected side

· Limited shoulder movement

 

What are the risk factors?

· Repetitive overhead activity (e.g. sports or manual work)

· Trauma

· Age-related degeneration (more common over 40)

· Shoulder trauma or dislocation

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How is it diagnosed?

· A physical examination to assess strength, movement, and tenderness

· X-rays may show associated arthritis or bony changes

· MRI to confirm the size and location of the tear as well as tissue quality, reparability and degree of retraction

 

What are the treatment options?

· Non-surgical treatment includes rest, physiotherapy, anti-inflammatory medication, and cortisone injections

· Surgery may be recommended if symptoms persist or the tear is large

· Surgical options involve arthroscopic repair of the torn tendon(s)

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When is surgery required?

· When pain and weakness do not improve with non-operative treatment

· Acute full thickness tears in young patients

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What happens if this condition is left untreated?

· Small tears may enlarge over time

· Ongoing pain and weakness can affect work, sleep, and daily activities

· Delayed treatment may reduce the success of future repair as the tendons may be come more retracted with time.

· Large & retracted tears which are left unrepaired may undergo ‘fatty infiltration’ over time. This is when the muscle    is replaced by fatty tissue and the tear becomes irreparable.

· Irreparable tears may be treated with physiotherapy, reverse shoulder replacement or tendon transfers

 

How long is the recovery following surgery?

· First 6 weeks:

o Arm is kept in a sling to protect the repair

o No lifting or overhead movement

o Hand and elbow use allowed for light tasks

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· 6 to 12 weeks:

o Gradual shoulder movement is introduced

o Physiotherapy focuses on range of motion and early control

o Strengthening begins at the end of this phase

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· 3 to 6 months:

o Most daily activities can be resumed

o Strength training continues

o Pain and mobility gradually improve

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· 6 to 12 months:

o Full recovery is expected by 9–12 months for most patients

o Return to sports or heavy work depends on healing and rehabilitation progress

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What are the expected outcomes of surgery?

It is important to note that the success of rotator cuff repair depends on factors such as tendon quality, tear size, and patient adherence to rehabilitation. Larger or chronic tears may have a higher risk of incomplete healing due to tendon degeneration or muscle atrophy. While most patients experience significant improvement in pain and function, full strength and range of motion may not always be restored.

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What are the risks of surgery

Despite taking the utmost precautions to ensure a safe and smooth recovery, rotator cuff repair carries inherent risks. These may include, but are not limited to, infection, bleeding, injury to surrounding nerves or blood vessels, shoulder stiffness, failure of tendon healing, re-tear of the repair, or the development of complex regional pain syndrome (CRPS).