Rotator cuff tears can be caused by a progressive impingement as described above or acutely following trauma.

Different stages described in rotator cuff tears:

•    Stage 1 involves the swelling and bleeding process, which is common in the younger patient particularly with overhead activities. The patient feels aching during and after activity and is usually uncomfortable at night. Pain is often radiating down the arm.
•    Stage 2 involves the thickening and inflammation of the tendons caused by repeated injury. These are commonly more common in the 25 to 40 years of age group. The joint is usually stiff and they usually get catching pain when returning from elevation. When the shoulder has reached this stage, rest and avoidance is not sufficient in reducing pain. Sometimes the biceps tendon is also involved.
•    Stage 3 is characterised by tendon degeneration, bony sclerosis, spurs formation and tendon ruptures. This rarely happens to anyone less than 40 years of age and usually follows a long history of shoulder problems. A partial tear shows pain, stiffness weakness and disability in the affected arm, with the pain often being worse at night.

With a degenerated tendon, minor trauma can cause a full thickness tear, which is characterised by sudden weakness, and are confirmed by arthroscopy, MRI or ultrasound.

A full thickness tear can also be caused by a fall onto an outstretched arm, when the force of the muscle contracting tears the tendon from the bone.

Full thickness tears are usually surgically repaired but some elderly patients are not put through the surgery if they can manage functionally without it.

Physiotherapy treatment

May concentrate on restoring full mobility, decreasing pain and inflammation, improving strength and restoring correct biomechanics.