Rotator cuff tears are a common source of pain in the active population above the 50th year of age. “Rotator cuff disease” describes a degenerative process that starts with tendinitis, then partial tears and finally full thickness tears. Degenerative rotator cuff tears occur in about one third of the over 50 years old population (partial or full thickness). This percentage rises with age. 50 to 80% of these tears progress within 5 years. When suspected, diagnosis is often confirmed with ultrasound or MRI. These tears are treated non-operatively first, with analgesia and specific exercises. Surgical repair is possible but there are many factors that influence the success rate. These include the age of the patient, the size of the tear and the quality of the tendon.
Rotator cuff tears must also be suspected if there is weakness or lack of movement with a history of trauma, no matter how trivial. General practitioners, A&E doctors, physiotherapists and other allied services are often the first to see patients with shoulder injury. Early diagnosis is important. Patients often attend A&E and have a normal X-ray, but if they are not improving clinically, then there should be a low threshold for investigations to ensure the best outcome. Traumatic tears have better outcome with early surgery. Unfortunately, many of these tears are missed as an X-ray is done and patients are reassured. As a result, any persisting pain in a shoulder should be imaged to assess the rotator cuff.
Rotator cuff tears are repaired with arthroscopic rotator cuff repair which is a keyhole operation and is mostly done as a day case procedure. Following surgery there is a period of rehabilitation.