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The rotator cuff is made up of the four tendons that connect the muscles of the shoulder blade (scapula) to the upper arm bone (humerus). These help control the movements of the ball and socket joint of the shoulder.
Tears can occur in tendons weakened by age, inflammation, disease, trauma, daily wear and tear, and repetitive strain. Tears can also occur in younger people following sudden, major trauma. The tendons most commonly tear at their insertions (where the tendon joins the muscle to the bone). Tears do not generally heal by themselves as this area of the tendon has a poor blood supply.
Magnetic Resonance Imaging (MRI) studies of patients without symptoms over the age of 60 years suggest that tears may be present in around 50% of this population. Full thickness tears make up approximately half of these and partial thickness tears the remainder. MR scanning is only 75-95% accurate in diagnosing rotator cuff tears so the true number of degenerate tears of the rotator cuff in the population is unclear.
Tears of the rotator cuff range from a partial tear in one tendon to complete tears of one or more of the tendons. In partial tears only some tendon fibres are torn resulting in weakness of the tendon. This can cause significant discomfort but there may not be too much loss in arm movement. With time however partial tears can worsen. Further disruption of the remaining tendon fibres may occur producing a full-thickness tear. A larger tear usually results in more weakness and pain. Depending on its location, a full thickness tear can lead to a complete rupture of the tendon as the tendon completely tears off the bone.
Your surgeon will usually be able to diagnose the presence of rotator cuff damage on the basis of your symptoms and an examination. This may need to be supplemented by an ultrasound or MRI scan in order to define the site, extent and nature of the tear. Further imaging can also help to assess whether a tear can be repaired. Often a final assessment is only possible at the time of surgery.
Partial under surface tears will heal in approximately 10%. A further 10% will decrease in size and 80% enlarge to become full thickness. 50% of patients with an tear but no symptoms will become symptomatic over a five-year period. Full thickness tears are likely to become symptomatic.
A complete tear will not heal by itself. In these cases, surgery is the only means of repairing a tear. The aim is to improve shoulder function and comfort by repairing any tears in the tendon if necessary reattaching the tendon to bone. In older patients (>60 years), patients with low demand or in cases where there is an irreparable tear, decompression of the tendons alone may be performed to provide pain relief.
The success of surgical treatment depends on the size, thickness and location of the tear and the quality and amount of remaining normal tendon tissue. Early treatment is generally preferred as the outcome of surgery is often worse when a tendon has been torn for some time.