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Rotator Cuff Tear

The rotator cuff is the name for the tendons that surround the shoulder joint. The rotator cuff is important in allowing the shoulder to function through a wide range of motions. In part due to the rotator cuff, the shoulder joint can move and turn through a wider range than any other joint in the body. This motion of the shoulder joint allows us to perform an amazing variety of tasks with our arms. Unfortunately, a rotator cuff tear is not an uncommon problem, and these injuries make many routine activities difficult and painful. The rotator cuff is part of this mechanism which when healthy functions very well, but when injured can be a difficult and frustrating problem.

The rotator cuff is a group of four muscles and their tendons that wrap around the anterior (front aspect), superior (top) and posterior (back) of the shoulder joint. The rotator cuff enables the shoulder to move in many directions.

It also helps keep the shoulder in joint (stabilizes the joint). The muscles of the rotator cuff form tendons which end by attaching to the outer part of the top of the humerus (arm bone).

Rotator cuff tears occur in many shapes and sizes, but can be thought of as a hole in this group of the tendons around the shoulder joint. Mostly, they can be caused by an injury/ traumatic event (More common in the young or middle aged, this typically can be caused by a fall onto the shoulder or arm) or by repeated use/ degeneration (more common in the middle aged and elderly, repetitive use leads to weakening and thinning of the rotator cuff eventually leading to a tear).

The most common symptoms of rotator cuff tears are:

1. Pain
2. Reduced motion/strength and loss of function.

Patients typically go to their doctor with pain in the outer aspect of their upper arm, made worse by overhead activity (such as brushing hair, DIY, putting the washing out to dry). They find it increasingly difficult to raise their arm above their head and certain daily activities become more troublesome (eg. clasping a bra behind their back, reaching behind their back, or sleeping on the affected shoulder).

Many rotator cuff tears do not need surgery and the first step in treatment is usually with conservative measures. The first steps of rotator cuff treatment include Physiotherapy, anti-inflammatory/ analgesic medication, steroid injection to the shoulder. These treatments aim to help the patient reduce their symptoms and improve their motion and strength, but will not repair the tear. Younger patients and those with tears from an injury or traumatic event, especially in younger patients, will more likely require surgery.

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