The rotator cuff is a group of muscles and tendons that forms a protective layer around the shoulder joint. The muscles originate from the shoulder blade and attach to the humeral head. The four tendons are essential for the mobility and stability of the shoulder joint.

A rotator cuff tear refers to damage or injury to one or more of the tendons that make up the rotator cuff. A tear may affect part of a tendon or the entire tendon. Some tears are the result of degenerative changes. For example, if all 60-year-olds were to undergo an MRI scan, approximately 50% would be found to have a tear or partial tear of the rotator cuff. These tears do not always cause symptoms and therefore do not necessarily require treatment. In complete tears, the tendon is detached from the bone.

Partial tears can occur within the tendon (intratendinous), on the upper surface of the tendon (bursal-sided partial tear), or on the underside of the tendon (articular-sided partial tear, also known as a PASTA lesion).

Many people affected experience pain in the shoulder, particularly in the upper arm. Symptoms often occur during rotational movements or when raising the arm away from the body, for example when reaching for a wallet in a trouser pocket or while styling the hair. Pain also frequently occurs at night and can disrupt sleep.

A tear caused by an injury is often associated with acute pain, restricted movement, and reduced strength. Gradual degenerative changes resulting from wear and tear can cause similar symptoms.

The physician can often make an initial assessment based on the medical history and physical examination. To confirm the diagnosis and establish a basis for further treatment, imaging techniques such as X-rays, ultrasound examinations, magnetic resonance imaging (MRI), or computed tomography (CT) may be performed.

X-rays can be used to assess the bony structures, calcifications, osteoarthritis, and the position of the shoulder joint. Ultrasound allows for a dynamic examination and can reveal injuries to the rotator cuff. MRI, ideally with contrast medium, provides a detailed assessment of the extent of tendon retraction and the quality and degree of fatty infiltration of the muscles. The degree of muscle fatty infiltration is classified according to Fuchs on MRI or Goutallier on CT.

A CT scan provides detailed images of the bony structures and allows a three-dimensional reconstruction of the shoulder. It can also be used to assess fatty infiltration of the muscles.

The treatment of a rotator cuff tear depends on many individual factors. Traumatic and degenerative injuries are assessed differently when considering conservative and surgical treatment options. The patient’s daily activities, occupation, and age also play an important role in selecting the appropriate treatment. The location and extent of the tendon tear are equally important factors.

As an initial treatment, pain-relieving medication and injections into the shoulder are often administered. At the same time, physiotherapy or other functional treatments can help improve shoulder strength and mobility.

Completely torn tendons cannot heal back together on their own, as the tension within the muscles pulls the torn ends apart. However, some tendon tears can be treated successfully without surgery. This is because certain muscles and tendons can partially compensate for each other and support movement.

For example, a patient may still be able to move the arm despite a supraspinatus tendon tear, but experience discomfort when lifting weights. Movement can be supported by the infraspinatus and deltoid muscles. The body can partially compensate for the loss of function of individual tendons.

On the other hand, a traumatic, complete rupture of the subscapularis tendon is more likely to be an indication for surgery. Rotator cuff tears are classified according to the Lafosse classification.

If conservative (non-surgical) treatment has been unsuccessful, surgery may be indicated. Such procedures are now usually performed entirely arthroscopically using an endoscope, also known as keyhole surgery.<br><br>Before repairing a tendon, it must be ensured that the muscle, which acts as the motor of movement, has not undergone excessive fatty infiltration (>50%). For example, replacing a car wheel would not solve the problem if the engine were damaged.<br><br>The type of surgical treatment depends on the severity and nature of the injury. The available surgical techniques and treatment options will be discussed with you during a personal consultation with your physician.