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The rotator cuff is group of four tendons, which are attached to the top end humerus. These tendons form a cape or a “cuff”, which is present on top of shoulder joint. They help lift and rotate the arm and also to stabilise the ball of the shoulder joint. These tendons can tear and cause symptoms.


Rotator cuff tears are more common in people above the age of forty although they can occur in younger people. Often cuff tears can occur because the rotator cuff becomes pinched between the shoulder and the bony arch above it. They can also occur due to age related wear and tear in the tendon. Excessive sudden forces like heavy lifting, jerking motions, falling onto the arm or shoulder dislocations can cause full thickness tears of the tendons. They can also be caused by repetitive activity.




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The symptoms are very similar to impingement. The pain is usually over the front and outer aspect of the shoulder. The pain is particularly worse with activities above shoulder level or behind the back. The pain moves into the outer aspect of the upper arm. Often this is the main site of the pain. The pain is very common in the night causing considerable difficulty sleeping. As the tear progresses there is weakness when moving the arm. Pain can be experienced whilst lowering the arm from a fully raised position. It is not uncommon to feel a sharp pain with a snapping or popping sensation following an injury.  



Taking a good history and performing an examination is essential. It is often possible to isolate the tendons to get a better idea if there is weakness, which would suggest that a particular tendon is torn. Often a test is performed in the clinic by injecting a local anaesthetic into the area between the acromion and the rotator cuff. Occasionally it also necessary to perform MRI scans with a dye to ensure that there are no other problems in the shoulder and also to investigate the exact dimensions of any tears.  



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In the early stages of rotator cuff tears ice, rest and avoidance of overhead activities can be beneficial. Anti-inflammatory medication helps during the acute phase as can targeted exercises by your physiotherapist. The physiotherapist's aim is to build the rotator cuff muscles. If one tendon is torn the remaining three can compensate and maintain motion and strength. It is always important to try these conservative measures before considering surgery.


If conservative measures fail then surgery is indicated. Surgery is often performed using the keyhole method. A half centimeter incision is made at the back of the shoulder and a telescope is introduced into the subacromial space. Scar tissue is removed and decompression performed. This means that the spurs from the acromion and the acromio clavicular joint are removed. The rotator cuff is then examined. Most tears are repaired using keyhole surgery. For this two or three smaller incisions are made over the side and the front of the shoulder. These are to introduce instruments to try and repair the torn tendon. Small screws known as anchors are inserted into the top of the humerus. These anchors have sutures attached to them. The sutures are then passed through the torn tendons and tied to bring them back into bone. On some occasions when the tear is very large it may be necessary to make a small cut in order to repair the tendon by direct vision. If the tear progresses, it starts retracting into the body. Once the tendon retracts past 3-4 centimeters it is impossible to repair it. It is therefore crucial that surgery is undertaken at an early stage.