Shoulder Tear (Rotator Cuff Injury)
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and enabling the wide range of arm movements the shoulder is capable of. Tears — either partial or full-thickness — of these tendons are one of the most common sources of shoulder pain and disability, particularly in middle-aged and older adults.
Causes
Rotator cuff tears occur through two broad mechanisms. Acute tears result from a sudden injury — such as a fall onto an outstretched hand, a heavy lifting episode, or a shoulder dislocation. Degenerative tears develop gradually over time as the tendons weaken with age, repeated microtrauma, and reduced blood supply — they are particularly common in the supraspinatus tendon, which runs through a narrow space beneath the acromion bone. Risk factors include advancing age (tears become considerably more prevalent after 60), overhead repetitive activities (common in painters, construction workers, and certain athletes), previous shoulder injury, and smoking (which impairs tendon healing).
Symptoms
The typical presentation is pain over the outer aspect of the shoulder and upper arm, which is worse when reaching overhead or behind the back. Pain at night — particularly when lying on the affected side — is a hallmark feature that often prompts patients to seek help. Depending on the extent of the tear, there may also be weakness when lifting the arm or rotating it outwards, and a catching or grinding sensation with movement.
Diagnosis
Clinical examination assessing range of motion and specific rotator cuff strength tests is informative. MRI is the gold standard for confirming and characterising a tear, distinguishing partial from full-thickness tears and assessing tendon quality (important for surgical planning). Ultrasound is a useful, accessible alternative.
Choosing where to be treated
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