The rotator cuff is a strong group of tendon tissue connecting muscles from the shoulder blade (scapula) to the upper arm (humerus).

It is made by the tendons of four muscles, the supraspinatus, subscapularis, (infraspinatus and teres minor. The role of the rotator cuff is to keep the ball of the shoulder joint firmly in the socket, so the strong muscles around the shoulder can move the arm into all positions.

Although problems can arise in any of the tendons of the rotator cuff. The supraspinatus is the most commonly affected, it has a relatively poor blood supply and passes through a narrow arch under the acromion bone just above the shoulder joint..A lubricating membrane called the subacromial bursa allows the supraspinatus tendon to glide smoothly under the acromion as the arm moves.

What happens if the Rotator Cuff is damaged?

The rotator cuff of the shoulder can be damaged by trauma or repetitive overuse during work or sport activities. It may also be affected by wear and tear as we get older, a spur from the acromiumbone (subacromial Impingement) or calcium formation (Calcific Tendonitis)

The supraspinatus tendon may become abnormal due to these stresses, it can become inflamed and swollen. It may rub against the overlying acromion. This may cause the subacromial bursa to become inflamed (bursitis). These conditions may cause shoulder pain, poor movement and weakness of the shoulder. All activities including sleep can be affected. The supraspinatus (and other tendons) may tear.

Tears of the rotator cuff may be either partial-thickness or full-thickness, and may involve any of the tendons. Sometimes this leads to arthritis (cuff tear arthropathy).

How do you treat rotator cuff problems?

Treatment depends on various factors but often simple painkillers including anti-inflammatories or modifying daily activities may help..

If these don’t work, then physiotherapy, or injections can often improve things significantly.

Sometimes surgery may be indicated. The commonest from of surgery is a simple day-case, key-hole operation called a subacromial decompression. In this operation a small amount of bone is shaved from the underside of the acromion to make more room for the supraspinatus tendon to glide underneath. During the operation, inflammatory tissue is also removed and this increases the space for the rotator cuff tendons to move, reducing the friction between the structures.

Normally patients do very well with this operation and the vast majority are significantly better than they were before the operation.

If there is a complete rotator cuff tear it will not normally heal by itself and may need surgery. This surgery is normally a key-hole operation where an anchor and special stitches are used to stitch back the torn rotator cuff tendons back to the bone from which it was torn from. Sometimes many anchors are used depending on the size of the tear.

To help the tendons to heal, the arm will be in a sling for 3-4 weeks. During the initial period patients will not be able to drive.