Rotator cuff tear

The rotator cuff is a group of four muscles and their tendons that hold the ball of the shoulder in its socket and help lift and rotate the arm. A tendon can tear from an injury such as a fall, or gradually from wear over time.

• Pain at the front or outer side of the shoulder, often spreading down the upper arm
• Pain at night, especially when lying on the affected side
• Weakness when lifting or rotating the arm
• Difficulty reaching overhead or behind the back
• Crackling or catching with certain movements

Diagnosis begins with an examination of shoulder strength and motion. X-rays, ultrasound, or MRI can show the tendons and the size of a tear.

Non-operative treatment includes activity changes, physical therapy to strengthen the remaining rotator cuff and shoulder blade muscles, anti-inflammatory medication when appropriate, and sometimes a steroid injection. Many partial tears, and some full-thickness tears that develop gradually, are managed this way.

Surgical repair reattaches the torn tendon to the bone, usually arthroscopically. It may be recommended for tears caused by a sudden injury, for significant weakness, or when pain and function do not improve with non-operative care. After repair, the arm is protected in a sling for a period, followed by a gradual rehabilitation program over several months. For some large tears that cannot be repaired, other procedures, including types of shoulder replacement, may be discussed.