In the shoulder, there is a group of muscles and tendons surrounding the shoulder joint. Their purpose is to keep the head of the upper arm bone within the socket of the shoulder. As such they are vital to the proper functioning of the shoulder.
Problems arise when a tear to the rotator cuff happens. This can occur over time in people who repeatedly carry out overhead tasks. An example of this would be a painter/decorator.
Such injuries can also arise suddenly from trauma caused by a fall or from lifting something heavy. When patients present to the hospital with a shoulder injury, it should prompt a question about the method of fall to identify the likelihood of rotator cuff injury.
Where there has been a tear that affects a significant portion of the tendon then it will cause weakness to the shoulder, limiting the ability to hold the arm out to one side and to lift an object. There will be difficulty with being able to place the hand behind the back. Such problems should be identified from proper medical examination. This should include the doctor rotating the arm at the shoulder and then raising the arm. If this type of motion causes pain, the rotator cuff may be inflamed.
If a rotator cuff tear is suspected then radiological examination should be undertaken. The gold standard assessment is MRI scan, although ultrasound is also routinely used.
Where there is a large rotator cuff tear then surgery may be necessary. It is important that this occurs as soon as possible following traumatic injury, ideally within 6 weeks, because over time the rotator cuff muscle can weaken and retract. This makes surgery more difficult and less likely to achieve an optimal outcome. Therefore delay may well mean that the long-term shoulder function is compromised.
At Hugh James, we have unfortunately seen many cases where there has been a failure to identify and treat a rotator cuff tear. This has been either from a failure to carry out a proper examination or from failing to diagnose the tear on any radiological investigations. Because of the delay, this has severely affected the long term shoulder function.