Rotator cuff tear: symptoms and effective treatment of rotator cuff tear

Shoulder pain, limited mobility and loss of strength – these complaints are often caused by a so-called rotator cuff tear. This is a tear in one or more tendons that stabilize the head of the humerus. The injury can occur suddenly or develop gradually over years in the joint. In our specialized shoulder practice in Munich, we specialize in the diagnosis and treatment of rotator cuff tears and accompany you on the way back to pain-free movement.

What is the rotator cuff?

The rotator cuff consists of four muscles and their tendons that surround the shoulder joint. The rotator cuff tendons are:

• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

Together they ensure stability and mobility of the shoulder - especially when lifting and turning the arm. When a rotator cuff tear occurs, one or more of these tendons tears - either partially (partial tear) or completely (complete damage).

Causes: How does the rotator cuff tear occur?

A rotator cuff tear can have various causes. The most common causes of a rotator cuff tear include:

1. Degenerative (due to wear):

Over the years, tendon tissue loses elasticity and becomes more susceptible to tears. Small micro-injuries caused by wear and tear during overhead work, sports, or poor posture and restricted movement of the shoulder blade can develop into a tendon tear over time.

2. Traumatic (due to accident):

A fall on an outstretched arm or an abrupt, jerking movement can lead to a sudden tear - often in younger or physically active people.

3. Secondary to other shoulder problems:

Impingement syndrome (narrowing under the acromion) or a calcified shoulder can put additional strain on the tissue and lead to a tendon tear.

Typical symptoms of a rotator cuff tear of the shoulder

The symptoms depend on whether the tear occurred suddenly or gradually:

Pain on exertion, especially when lifting the arm e.g. combing the hair

Night pain, especially when lying on the affected side

Loss of strength when lifting or rotating the arm, e.g. carrying shopping bags

Movement restrictions

Cracking or rubbing noises in the shoulder joint

In the case of an acute rupture, the pain can be very severe and the ability to move can be suddenly restricted.

Diagnosis of a rotator cuff tear

The diagnosis of a rotator cuff tear can often be made clinically. In our practice we carry out a thorough clinical examination. We specifically test the mobility, strength and pain points of your shoulder. Modern imaging procedures are used for further clarification:

Ultrasound – an ultrasound examination is suitable for a quick assessment directly in the practice

MRI (magnetic resonance imaging) – for a precise depiction of the tendon tear, its size and possible accompanying injuries

X-ray – to assess the bony structures

Treatment of a rotator cuff tear: conservative or surgical?

The choice of orthopedic therapy depends on the extent of the rupture, age, physical strain and individual limitations.

Conservative therapy

For small or painless partial tears, surgery can often be avoided. The aim is to maintain the function of the shoulder through targeted measures:

Physiotherapy to strengthen muscles and relieve strain on the tendon

Pain and inflammation inhibition through medication or injections

Everyday adjustment to avoid further irritation

This form of therapy is particularly suitable for older patients or people with only minor functional losses.

How long should I carry out conservative treatment and when is surgery recommended for rotator cuff problems?

Surgery is recommended if:

the symptoms complained about persist despite therapy

the tendon is completely separated and the function is impaired

the shoulder is severely weakened

younger or active patients are affected

You should prepare accordingly for treating illnesses and injuries to the shoulder as well as signs of wear and tear on the cuff. If there is damage to the supraspinatus tendon or if several rotator cuff tendons are worn, the limb will be immobilized for a short period of time after the procedure. Raising the arm initially only occurs as part of physical therapy, passively or by using a movement chair. During the course, exercises to strengthen the muscles are necessary in order to prepare the rotator cuff muscles and the joint in a centered manner for sporting activities.  

How is surgery performed and how can I prepare for surgical treatment?

In most cases, the procedure is carried out arthroscopically (keyhole technique). The torn tendon is reattached to the bone in a minimally invasive manner using small instruments during arthroscopy. In severe cases, reconstructive surgery of the shoulder joint or - in the case of very extensive damage - an artificial tendon transfer, a capsule reconstruction between the socket and the humeral head or a reverse shoulder prosthesis may be necessary.

Rehabilitation and chances of recovery from rotator cuff tears

After an operation, structured follow-up treatment is crucial. As a rule, there is initially a rest phase with immobilization, followed by controlled physiotherapy. Depending on the type of procedure, rehabilitation lasts between 6 and 12 months. The chances of recovery are very good with early diagnosis and consistent follow-up treatment - many patients completely regain their shoulder function.

Conclusion: Early therapy pays off

A rupture of the rotator cuff is not a trivial matter - if left untreated, it can lead to permanent restrictions on movement in the shoulder area or shoulder osteoarthritis. The earlier the right therapy is started, the better the chances of recovery. In our shoulder practice in Munich, our orthopedist Prof. Ockert offers you individual, holistic care - from the first consultation to complete recovery.

Do you have shoulder pain or problems lifting your arm? Make an appointment now with your shoulder specialist in Munich – we will help you competently and personally.