Rotator cuff tears are one of the most common causes of shoulder pain and disability, particularly in adults aged 40 and above. These tears can make simple daily activities, such as combing your hair or reaching behind your back, painful and difficult. In Singapore, many patients seek help from an orthopaedic specialist when shoulder pain and weakness interfere with work, exercise, or quality of life.
What is the Rotator Cuff?
The shoulder is a ball-and-socket joint, similar to a golf ball resting on a tee. The “ball” is the head of the upper arm bone (humerus), while the “socket” is part of the shoulder blade (scapula).
Surrounding this joint are four muscles and their tendons, collectively known as the rotator cuff. These stabilise the shoulder and allow you to lift and rotate your arm:
- Supraspinatus: The most commonly injured tendon, responsible for lifting your arm forwards and sideways
- Infraspinatus: Helps rotate your arm outwards (external rotation)
- Subscapularis: Assists in rotating your arm inwards (internal rotation)
- Teres minor: The least commonly injured tendon, also aids in external rotation
What is a Rotator Cuff Tear?
A rotator cuff tear occurs when one or more of these tendons are damaged. Tears can range from partial tears, where the tendon is frayed, to complete tears, where the tendon separates entirely from the bone.
Causes of Rotator Cuff Tears
Rotator cuff tears may develop in two main ways:
- Acute or Traumatic Tear: Often the result of a fall, a sudden heavy lift, or a direct blow to the shoulder. These tears are more common in younger individuals.
- Degenerative Tear: The more common type, especially in adults over 40. Tendons weaken and wear out over time due to natural ageing. Repetitive overhead activity, bone spurs, or long-term overuse can contribute to these tears. Large untreated tears may worsen over time and lead to arthritis in the shoulder joint.
Symptoms of Rotator Cuff Tears
Common signs of a rotator cuff tear include:
- Pain: Sharp pain or a dull ache in the shoulder, which worsens with arm movement or at night. Pain is often felt in the neck or upper arm but rarely extends into the hand.
- Weakness: Difficulty lifting the arm overhead or performing simple tasks such as reaching behind your back, combing your hair, or dressing.
- Restricted Movement: Reduced shoulder range of motion due to pain or weakness. Some patients with long-standing tears may also develop shoulder arthritis, which further limits movement.
Diagnosis of Rotator Cuff Tears in Singapore
If you suspect a rotator cuff tear, a shoulder specialist in Singapore will usually:
- Take a detailed medical history and assess your symptoms
- Perform a physical examination to check your strength, range of motion, and shoulder stability
- Order imaging tests:
– X-rays: To rule out arthritis, bone spurs or fractures
– Ultrasound: To visualise tendon tears in real time
– MRI: The most accurate test, showing the size, location and severity of the tear as well as other joint structures
Treatment for Rotator Cuff Tears in Singapore
Treatment depends on the size and severity of the tear, your age, activity level, and overall health. The main goals are to relieve pain, restore strength, and improve shoulder function.
Non-Surgical Treatment
- Rest: Avoid activities that worsen pain, especially lifting heavy objects overhead
- Pain Medication: Over-the-counter or prescribed medications to control pain and inflammation
- Physiotherapy: Essential for recovery, focusing on exercises that improve range of motion, strength and stability. Therapists may also use techniques such as ultrasound, radiofrequency or dry needling
- Injections: Corticosteroid injections or platelet-rich plasma (PRP) injections may help reduce pain and inflammation, though not suitable for everyone
Surgical Treatment
Surgery may be recommended if:
- You have a large or complete rotator cuff tear
- The tear resulted from a sudden injury
- Pain and weakness persist despite non-surgical treatments
Most rotator cuff repairs are performed arthroscopically (keyhole surgery) using small incisions, a camera, and specialised instruments. The torn tendon is reattached to the bone using suture anchors. Bone spurs may also be removed to prevent further tendon damage. Surgery typically lasts 1 to 2 hours.
In older patients with very large tears or arthritis, shoulder replacement surgery may be a better option. This involves replacing the ball-and-socket joint with artificial components.
Recovery and Rehabilitation
After rotator cuff surgery:
- An arm sling is worn for 4 to 6 weeks to protect the repair
- Pain relief with medication or ice packs is usually needed for 2 to 6 weeks
- Physiotherapy begins with gentle exercises, gradually progressing to strengthening over 3 to 6 months
- Most patients regain good shoulder function and are able to return to daily activities
Conclusion
Rotator cuff tears are a common cause of shoulder pain in adults, especially those over 40. With proper diagnosis and treatment, many patients are able to recover shoulder strength and return to normal activities.
If you are experiencing persistent shoulder pain or weakness, consult a shoulder specialist in Singapore. Early treatment can prevent the condition from worsening and help you regain full use of your shoulder.
