Rotator Cuff Problems & Shoulder Pain

Who does this affect? Any age group, particularly in middle years and above. It can occur either from repetitive activity or a "one-off" movement, such as a fall. It can also be due to a shoulder dislocation.

Symptoms Shoulder pain - muscle strains, particularly of the rotator cuff (tendonitis) are common. This is often known as "impingement" pain. Early assessment and treatment is crucial to avoid chronic symptoms.

Rotator cuff tendon tears or splits are often not identified for a long time. Often patients fall and have severe shoulder/arm pain. They attend A&E but X-rays are normal. These injuries can cause long-term shoulder pain often with arm weakness. Prompt diagnosis and repair (surgery) gives the best chance of successful outcome and return to full activity.

Investigations A clinical exam and plain X-rays are essential. After this, usually an MRI scan or Ultrasound scan is used to confirm the diagnosis.

Non-surgical Treatment If the tendons are strained / inflamed (tendonitis or impingement) but not torn, then a cortisone -steroid- injection and physiotherapy is the first line of treatment. This is successful for over 50% of patients.

Surgical Treatment Some patients with Impingement do not settle with injection and physiotherapy.  "Keyhole" surgery - Arthroscopic Subacromial Decompression -is very successful for pain relief in these individuals.  This is done as a day case with a general anaesthetic.  A thick ligament and any bone hook  are removed with special instruments through 2 small incisions. Arthritis of the joint where the collarbone(clavicle) meets the shoulder blade tip (acromion) -the AC joint- can also be dealt with at the same time through a 3rd small incision. Patients wear a sling for a short time and typically return to activities over 3 to 6 weeks.

In this picture, the scuffed cuff tendons are seen at the bottom. The bone has been flattened to increase (decompress) the sub-acromial space.

If the rotator cuff tendon is torn, then prompt surgery to reattach the tendon gives the best outcome. Increasingly, this is done by keyhole methods too.  This surgery takes longer and may involve an overnight hospital stay. The repaired tendon usually needs a period of relative rest for a few weeks after surgery to allow it to heal back down, before physiotherapy begins to strengthen the shoulder. Full recovery takes several months, though pain relief is usually quicker.

This picture shows the repaired cuff tear by a keyhole technique.

In this picture, the scuffed cuff tendons are seen at the bottom. The bone has been flattened to increase (decompress) the sub-acromial space.

If the rotator cuff tendon is torn, then prompt surgery to reattach the tendon gives the best outcome. Increasingly, this is done by keyhole methods too.  This surgery takes longer and may involve an overnight hospital stay. The repaired tendon usually needs a period of relative rest for a few weeks after surgery to allow it to heal back down, before physiotherapy begins to strengthen the shoulder. Full recovery takes several months, though pain relief is usually quicker.

This picture shows the repaired cuff tear by a keyhole technique.