Diagnosing and Treating Rotator Cuff Injuries

The rotator cuff is a group of muscles and tendons that surround your shoulder joint. They stablise the joint, keeping the head of your arm bone firmly within the shallow socket, and enable you to lift and rotate your arms.

---

What causes injury?

The rotator cuff can become torn due to normal wear and tear or as the result of overuse. This type of injury is particularly common in jobs or sports that require people to make the same arm motion over and over again, particularly repetitive overhead motions. Window cleaners, carpenters, painters and decorators and tennis players are all prone to rotator cuff injuries. However, the risk of rotator cuff tears also increases with age and can be caused by falling onto your arm or lifting something that is too heavy.

You may develop a partial tear, which is damage or fraying to one of the muscles, or a complete tear, which is where the tendon is completely torn or pulled away from the bone. Treatment will vary depending on how severe the injury is.

---

Symptoms of rotator cuff injuries

Most people with a rotator cuff injury experience a dull ache in the shoulder which may prevent them from sleeping on the affected side. Other symptoms include:

• Being unable to reach behind your back or comb your hair.
• Weakness in the affected arm, making it difficult to lift things.
• A clicking or popping sound when you move your arm.

---

Diagnosis of rotator cuff injuries

If you suspect you may have a rotator cuff injury it is important to get a proper diagnosis as continuing to use a torn rotator cuff can lead to a worsening of symptoms or more serious problems over time, such as arthritis or a frozen shoulder.

During a diagnosis, your doctor will examine your shoulder and check how well you can move it and whether there are certain movements that cause pain. Your muscle strength will also be assessed. To confirm the diagnosis, you may be referred for diagnostic imaging, which allows the doctor to see what is going on inside your shoulder joint. You may be given:

• An X-ray, which will show if the humeral head is pushing into the rotator cuff space.
• An ultrasound scan, which will provide a clear picture of the tendons, muscles and bursa in your shoulder. This type of imaging enables the radiographer to assess your shoulder as it moves and can also be used to compare the healthy shoulder with the damaged shoulder.
• An MRI scan, which provides a detailed picture of all of the structures of the shoulder using radio waves and strong magnets.

---

Treatment of rotator cuff injuries

Once you have received a diagnosis, your doctor will recommend a treatment plan, depending on the extent of the injury. Non-invasive treatments are always recommended for less severe tears and are often all that is needed. This might include resting the affected shoulder and using ice to reduce swelling and inflammation. Physiotherapy can also help to maintain mobility and prevent stiffness in the shoulder.

The following treatments might be used for more severe injuries:

• Painkilling injection: an injection of steroids into the shoulder joint can help to reduce the pain, particularly if it is interfering with everyday activities or sleep. However, pain relief tends to be temporary and steroid injections are not a long-term solution as they can lead to weakening of the tendon over time.
• Arthroscopic tendon repair: using keyhole surgery, an arthroscope is inserted into a small incision in the shoulder. A camera and miniature surgical instruments are used to repair or reattach torn tendons.
• Open surgery: where surgery is required but it is not possible to use keyhole surgery, a larger incision will be made and tendons will be repaired and reattached to the bone using open surgery. In some cases you may be able to have a mix of arthroscopic and open surgery, called a mini-open procedure.
• Tendon transfer: if the tendon is too damaged to be reattached, surgeons may transfer a nearby tendon to be used as a replacement.
• Shoulder replacement: if the rotator cuff injury is significant, you may need to undergo a complete joint replacement procedure. This entails removing the damaged joint and replacing it with a prosthetic implant.
• Physiotherapy: can help to improve flexibility and restore strength to the shoulder, particularly after surgery.

---

Recovering after rotator cuff surgery

If you undergo surgery for a rotator cuff injury you will normally need to wear a sling for four to six weeks while your shoulder recovers. Ice packs can be used to reduce swelling and you should avoid lifting your arm until the doctor advises that it is OK to do so. It can take up to a year for you to regain full use of your shoulder.

---

If you are experiencing shoulder pain or weakness and suspect you may have a rotator cuff injury, contact us to arrange a diagnosis and subsequent treatment plan.