Rotator cuff problems & shoulder pain

Who does this affect?

Any age group, particularly in middle years. 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 in the elderly.

Symptoms

Shoulder pain due to muscle strains, particularly of the rotator cuff, are common. This is often known as "impingement" pain. Early assessment and treatment is crucial to avoid chronic symptoms. Rotator cuff tendon tears are often not identified for a long time. These can cause shoulder pain often with muscle 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 is used to confirm the diagnosis and assess the size and position of the tear.

Non-surgical treatment

If the tendons are strained, then a cortisone injection and physiotherapy is the first line of treatment. This is successful for over 50% of patients.

Surgical treatment

"Keyhole" surgery known as Arthroscopic Subacromial Decompression, is used for patients whose pain persists. If the rotator cuff tendon is torn, then prompt surgery to reattach the tendon gives the best outcome. Cuff repair does mean a period of recovery to regain full use, with physiotherapy.

If the cuff is extensively torn and the ball head has started to migrate upward then shoulder debridement will offer some pain relief although the movement and power may not improve.