Rotator cuff tears: Why pathology isn’t always a problem

It can be quite common to have a sore or stiff shoulder at some point in your life, even without an injury.

People with a sore shoulder will often visit the GP as a starting off point. This would often result in a referral for an XRAY and diagnostic ultrasound to help aid in assessment.

All too commonly a scan of this description will show some form of pathology; most commonly a rotator cuff tear or bursitis. This sounds horrible and can create panic but as demonstrated below it doesn’t always mean there will be an ongoing problem.

Rotator cuff tears

Shoulder anatomy

The shoulder is a shallow ball and socket type joint which means it isn’t held in very well by the bones and ligaments and relies heavily on muscles to support it.

The Rotator Cuff is a group of four muscles that surrounds the shoulder and helps with stability of the shoulder and movements in all directions.

It is labelled a ‘cuff’ because the tendons of all four muscles mesh together and encapsulate the shoulder in a flat blanket like structure.

Keeping this in mind it is possible to have a tear in one of these muscles and as long as the others are in good condition you may be able to return to normal pain-free function.

How can a tear be normal?

As we age it is normal for certain parts of our body to become ‘worn’ looking under medical imaging. This is well documented in most body parts with the shoulder being no exception.

In a recent study of people aged 50 to 59 years, 13% of the patients had tears and as age increased the percentage of people that had tears also increased. In the oldset group sample of people older than 80, a significant 51 per cent of patients had tears in their rotator cuff shown on ultrasound.

Can a tear be abnormal?

Yes! If a rotator cuff tear is causing a severe lack of strength which is causing you to be restricted in day to day actions regardless of pain then your tear is abnormal and need a physiotherapist to assess it and help you with appropriate management strategies.

The main message we often try to get across to patients is:

How you move is much more important than what your scan looks like.

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