Rotator Cuff Tear

Understanding the rotator cuff

The rotator cuff is a group of muscles and tendons that help move the shoulder and hold the upper-arm bone in its socket. A tear can involve part or all of a tendon’s thickness. The importance of a scan finding depends on your symptoms and examination; some tears cause little difficulty. AAOS overview.

Start by describing the task that has changed. Are you struggling to lift a kettle, reach a shelf, put on a shirt or do your usual work? Explain whether pain stops the task or whether the arm feels weak even when the pain is manageable. You do not need to work out which tendon is responsible before seeking an assessment.

Symptoms and causes

Pain at night, discomfort lifting the arm and weakness are common reasons for assessment. Tears can follow an injury, such as a fall, or develop gradually as tendons change with age and repeated use. A sudden loss of function after an injury deserves timely clinical attention. AAOS symptoms and causes.

Make a note of when symptoms began, whether there was a single injury and which activities are now difficult. Mention previous shoulder treatment, neck symptoms and any earlier scans. If the problem arose gradually, describe the pattern rather than searching for one movement to blame. A short timeline helps the clinician understand what is new and what was already present.

It is useful to separate your main concern from the most dramatic phrase in a report. You might be worried about sleep, earning a living or losing independence. Say this explicitly. The consultation should help you understand what the findings mean for those concerns, rather than turning into a discussion of tear measurements alone.

Assessment and imaging

Examination assesses movement and strength and considers other causes of shoulder symptoms. X-rays show bone changes, while ultrasound or MRI can describe the tendons. Clinical findings and imaging are considered together when choosing treatment. Dudley Group NHS information.

Bring images as well as written reports if these are available. Ask whether the tear is considered recent or longstanding, whether the muscle and tendon quality matter, and whether another shoulder problem also needs attention. A finding that looks important on a scan may not explain every symptom; ask which part of your experience the proposed treatment is expected to address.

If two clinicians have offered different advice, bring both explanations to the appointment. Ask which assumptions differ: the main pain source, your functional demands, the repairability of the tear or the expected benefit of rehabilitation. This is more productive than asking which opinion is universally correct without the surrounding information.

Non-surgical treatment

Activity adjustment, appropriate pain relief and physiotherapy are possible first steps. Rehabilitation can improve shoulder movement and the function of supporting muscles. A steroid injection may sometimes be discussed for pain relief. Improvement in symptoms does not necessarily mean the torn tendon has healed closed. Dudley Group NHS treatment information.

Ask what the rehabilitation trial aims to achieve, how long it will be reviewed over and what would count as a useful response. Explain if your work involves overhead activity, lifting or carrying. A programme should make sense in the context of your day; advice for office work may not answer the needs of a manual worker or someone caring for a dependent relative.

Have exercises demonstrated and clarify the limits appropriate to you. Avoid inventing strenuous movements or repeatedly testing the arm with heavy weights. Pain medicines should be discussed with a clinician or pharmacist, especially if you already take other medicines. NHS shoulder self-care guidance.

When repair may be discussed

Surgery may be considered for persistent pain or functional weakness despite suitable conservative care, and for selected acute injuries. Repair generally reattaches tendon to bone. Tear size, tissue condition, activity needs and general health influence the discussion. Some tears require a different strategy because a straightforward repair is unsuitable. AAOS surgical options.

Possible complications include infection, stiffness, nerve injury, persistent symptoms and failure of tendon healing or another tear. An operation does not guarantee normal strength. AAOS risks and recovery.

Ask what the surgeon plans to do, what may change during the operation and how that would alter the instructions afterwards. Discuss the alternatives and what is known about the consequences of waiting in your particular case. Confirm the likely need for help with dressing, washing, transport and household work. These arrangements should be part of preparation, not an unexpected problem on the day of discharge.

Recovery and return to activity

A repaired tendon needs protection while healing, followed by staged rehabilitation. A sling and limits on active movement or loading may be prescribed. The exact progression depends on the repair and the treating team; small skin incisions do not mean the tendon is ready for early heavy use. AAOS rehabilitation discussion.

Ask for separate guidance about desk work, driving, lifting and sport. Keep the operative or discharge information available for your physiotherapist. If you receive instructions that appear to conflict, ask the teams to clarify them rather than selecting whichever seems easier. At follow-up, describe changes in sleep and everyday tasks as well as pain.

Urgent warning signs

Seek urgent assessment for severe sudden pain, a deformed or very swollen shoulder, inability to move the arm, persistent loss of feeling, an arm that is unusually hot or cold, or shoulder pain with fever. NHS warning signs.

Do not wait for an appointment message if these occur. For ongoing symptoms without urgent features, an assessment can connect the diagnosis with a realistic treatment plan and a clear point for review.

Keeping your records together

Keep your scan report, exercise instructions and current medicine list together so that each review starts with the same information.