Rotator Cuff Repair
Understanding the Shoulder & Rotator Cuff
The shoulder joint is made up of three bones:
The humerus (upper arm bone)
The scapula (shoulder blade)
The clavicle (collarbone)
It functions as a ball-and-socket joint, where the rounded head of the humerus fits into a shallow socket of the scapula. The rotator cuff is a group of four key muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—which converge as tendons around the head of the humerus, stabilising the joint and allowing smooth arm movements like lifting and rotation.
A bursa, a fluid-filled sac, sits between the rotator cuff and the acromion (top of the shoulder blade), helping the tendons glide freely. When the rotator cuff is injured or torn, the bursa often becomes inflamed, contributing to pain.
Types of Rotator Cuff Tears
Based on Severity:
Partial tear: Tendon is damaged but not completely severed.
Full-thickness (complete) tear: Tendon is completely detached from the bone.
Based on Location:
Articular-side tear: Inner surface, near the joint
Bursal-side tear: Outer surface, near the bursa
Causes
Rotator cuff injuries occur from:
Trauma (Acute Tears)
Caused by sudden stress such as a fall on an outstretched arm or lifting something too heavy. These injuries may be associated with dislocations or fractures.Degeneration (Chronic Tears)
Gradual wear and tear over time, often affecting the dominant arm. These are more common with age or repeated overhead movements in sports or jobs.
Contributing Factors:
Repetitive stress (e.g., athletes, laborers)
Poor blood supply with aging, impairing tendon healing
Bone spurs under the acromion causing impingement and weakening of the tendon
Symptoms
Pain at rest and during the night (especially while lying on the affected shoulder)
Pain or weakness during arm elevation or rotation
Cracking or popping sensation with certain movements
Sudden injuries may result in a snapping sound and immediate weakness
Gradual tears cause increasing pain with overhead activity, later even at rest
Treatment Options
Early diagnosis and treatment can prevent worsening damage and reduce the risk of progressing to cuff tear arthropathy—a condition that may require shoulder replacement.
Non-Surgical Treatment:
Rest & activity modification
Anti-inflammatory medications (NSAIDs like ibuprofen)
Physiotherapy to strengthen the shoulder and improve range of motion
Steroid injections to reduce inflammation
PRP (Platelet-Rich Plasma) therapy for selected cases
Surgical Treatment
Surgery may be advised if:
Symptoms persist for 6–12 months
The tear is large (>3 cm) and tissue quality is adequate
There is significant weakness or loss of function
A recent injury has caused the tear
Types of Surgical Repair:
Arthroscopic repair: Minimally invasive surgery using a camera and small instruments to reattach the tendon.
Open repair: Required in complex cases, using a larger incision for better access.
Tendon transfer: If the tendon is irreparable, a nearby tendon is used to restore function.
Shoulder replacement: In severe, irreparable cases, a reverse shoulder replacement is done to improve joint mechanics and stability.
