Rotator Cuff Tear: Weakness and Night Pain in the Shoulder

Symptoms

• Difficulty lifting the arm to the side and overhead, with pain at a particular arc
• Night pain, especially an inability to lie on the affected shoulder
• Trouble combing hair, reaching behind the back and to high shelves
• Weakness; the arm dropping when lifting something heavy
• Catching or crackling with movement

Causes

• Age-related wear: the repair capacity of tendon tissue declines with age
• Repetitive overhead activity: painting, carpentry, volleyball, swimming, handball
• Trauma: falling onto an outstretched arm or a sudden strain
• Impingement: repeated contact of the tendon beneath a bony prominence
• Smoking and diabetes, which affect tissue nutrition

Diagnosis and Treatment

Examination assesses the arc in which movement is painful, muscle strength and the site of tenderness. X-rays show the bony anatomy; MRI or ultrasound demonstrates the tendon itself.

Partial tears and limited symptoms are managed non-surgically: activity modification, a physiotherapy programme for the shoulder girdle and scapular muscles, and appropriate pain management. Full-thickness tears, tears following trauma and cases unresponsive to conservative treatment are treated with arthroscopic repair, in which the tendon is reattached to bone with sutures. In older patients with irreparable, extensive tears, shoulder replacement options are considered.