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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on  any treatment. If you have a problem please consult your doctor or specialist.
Rotator Cuff tear
What is it?
Cuff tear refers to damage to the tendons of the shoulder. Rotator cuff refers to the muscle tendon unit which ‘rotates’ the arm bone in the socket and it attaches to the top of the shoulder like a ‘cuff’ of arm portion of a full sleeve shirt. Like a cuff there is a gap in the lower quadrant where there is no tendon present. The rotator cuff tendon/muscle unit can be damaged and can tear due to various reasons. The commonest cause is natural attrition and about 6-10% population above the age of 60 may have a cuff tear without symptoms. With every progressive decade, the number of cuff tear literally doubles.  Other causes include fall, dislocation, sudden rapid contraction of the shoulder muscles but more commonly the tear is due to on-going pressure on the tendon from impingement.  In my opinion, if impingement should continue unabated, it will lead to a cuff tear.
The symptoms of a cuff tear are notoriously similar to that of impingement syndrome. Therefore diagnosis of this becomes difficult.  In addition to the pain, patients may also describe loss of strength. Pain is typically felt around the shoulder and is brought on by certain movements. It may often start after a minor trauma or some times following new activity like racquet sports or a DIY job. Typically, one may feel the pain when the arm is lifted forwards or to the side beyond 60 degrees and may completely disappear when the arm is lifted higher (hence the painful arc). In addition, moving the arm behind the body, i.e. to reach the hip pocket or when reaching for the seatbelt in a car, may reproduce the pain.
It is not uncommon to get ‘referred pain’ in the upper arm along the deltoid muscle or the biceps muscles. Some patients may also develop intermittent pins & needle sensation in their fingers or a dull ‘tooth ache’ like pain. It
is usually deep seated and cannot easily be pin pointed. The arc may be at higher range when there is arthritis in the acromioclavicular joint. (ACJ = joint between shoulder blade and collar bone).
Occasionally, when decompression is done, no obvious tendon tear is noticed. However, if the pressure on the tendon has gone past a turning point, then even after a successful decompression, a rotator cuff tear can develop in future. This is very much like milk boiling and spilling over even when the heat is stopped. (Milk = tendon, heat = pressure, turning off = decompression)
In majority of cases, simple forms of treatment will ease the pain. These include activity modification (see self-help leaflet for addressing shoulder pain), avoiding overhead activities, rest and a course of anti-inflammatory tablets. Well-directed physiotherapy may also give good pain relief. In some cases especially in chronic tear, one may need injection of cortisone (steroid) and local anaesthetic into the tight space to settle the inflammation and swelling. Improvement is usually gradual and may take place over many weeks or even months. If the pain should return, on selected occasions, the injection may be repeated.
Overall, a third of the patients will get better with activity modification, tablets and physiotherapy and a third get better with injections. Those who do not get better may require surgical intervention especially when the quality of life is affected. Surgical intervention is however usually recommended as the first choice if the tear should occur after a trauma.