The rotator cuff is the name for a group of four muscles that hold the top of the arm in place in the shoulder joint. Without them the shoulder would simply dislocate each time that we tried moving it. All these muscles are all connected to the scapula, shoulder blade at one end and the humerus or upper arm bone at the other and form a cuff around the shoulder joint, hence the name.
A rotator cuff tear is a tear in one or more of these muscles either through too much pressure being put on them or through wear and tear caused by overuse or just old age. One analogy I have heard is that of comparing the tendons of the rotator cuff to a tow rope. If you try pulling something that is too heavy the rope can tear or snap and if you have been using the same tow rope for several years it can become frayed through use.
Rotator cuff tears sometimes come about through a sudden trauma. If, for example, you fall and put your arm out to catch yourself the sudden load can tear the muscle. Lifting something that is too heavy could have the same effect but the damage would be different as the load is likely to be added more slowly. The rotator cuff can also just wear out through repeated use either through age or because a work or leisure activity over uses the muscle. Anyone who throws a baseball repeatedly is putting strain on their rotator cuff.
A tear in the rotator cuff has specific symptom such as weakness in the arm, pain when doing certain movements, especially reaching up or behind you. The test for a torn rotator cuff will usually involve getting someone to gently push against the doctor's hand whilst mimicking these movements; this will usually result in pain.
Treatment for rotator cuff tears can vary depending on the age of the person and the size of the tear. Short or small tears are easier to repair and may only need anti-inflammatory drugs and physiotherapy, whilst larger tears may involve keyhole surgery to repair the tear or free up space for the inflamed muscle to move more easily reducing or eliminating pain altogether.
The younger you are when you have surgery the greater the success rate. As you age the success rate of the procedure can drop to around 60%. It is sometimes worth thinking about what you see as a successful outcome. Obviously, if you are a serious sportsperson the ideal outcome would be a return to full fitness. On the other hand, if you lead a fairly sedentary lifestyle the aim may be to be able to carry out certain tasks and movements pain free.
Rotator cuff tears come in all shapes and sizes and consequently can vary quite considerably in treatment and prognosis. Physiotherapy will be involved in any treatment but it needs to be rotator cuff specific exercises aimed at exercising and strengthening the group of muscles without causing any further damage.
