→ a tear or sprain to the group of tendons that surrounds the shoulder joint.
The rotator cuff is the collective name given to four muscles and tendons (individually known as the supraspinatus, infraspinatus, subscapularis and teres minor) that are arranged around the shoulder joint, somewhat like the cuff of a shirt. Together, they provide support for the ball-and-socket (glenohumeral) joint at the upper end of the arm, and free movement of the arm during elevation and, particularly, rotation (hence the name).
One or more of the rotator cuff tendons can suffer tears, and those tears can happen in several ways. One of the most common ways is through acute injury – when throwing a ball or swinging a racket, for example, or by lifting a heavy weight or sustaining a heavy fall on the shoulder area. This is often the reason for rotator cuff damage in younger patients, though injuries of this kind can of course affect people of all ages. Another common cause is chronic overuse. Repetitive overhead actions like decorating, or bowling, can put the muscles under sufficient strain to cause tears, particularly if they happen after a period of relative inactivity. Age is another factor that predisposes people to rotator cuff problems; our muscles generally lose strength as we get older, meaning they are more prone to damage from our 40s and 50s onwards.
Common symptoms of a rotator cuff tear include pain or discomfort (particularly if lying on the affected shoulder at night, or when lifting and lowering the arm in certain directions), restricted movement, weakness in the arm or shoulder, and sometimes a grinding sensation during movement (known as crepitus). Damage from an acute injury may be much more obviously painful, but rotator cuff tears can also occur in the absence of noticeable pain or discomfort. Diagnosis starts with exploring your symptoms and any activities that might have caused the damage. You will also be given a physical examination, and you may be asked to have an x-ray or MRI scan.
Many rotator cuff tears can improve and heal without surgery. Where this is possible, we would look to manage the injury with physiotherapy, a careful programme of exercises, simple pain relief, and possibly steroid injections. Surgery may be recommended for more severe tears. The most common procedure involves re-attaching the torn tendon to the bone, but there are several different kinds of operation depending on the type of damage sustained.