Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Acute Rotator Cuff Tear

🩺 Introduction

An acute rotator cuff tear involves disruption of one or more of the rotator cuff tendons, most often the supraspinatus, infraspinatus, or subscapularis. It usually results from either:

⚡ A spontaneous rupture of a degenerate tendon under sudden stress (common in older adults).
🏋️‍♂️ A wrenching injury or heavy lifting in younger patients.
🦴 In older individuals, tears may occur post-dislocation of the shoulder.

📍 Injury Site

Most often the supraspinatus tendon (classic site, initiates abduction).
Can involve the infraspinatus (external rotation) or subscapularis (internal rotation).
Multiple tendons may be affected in severe trauma.

⚙️ Typical Mechanism

Sudden loading of a weakened tendon → spontaneous rupture.
High-force injuries (falls, sudden pulls, heavy weights) in younger adults.
Older patients: may follow anterior shoulder dislocation.

⚠️ Pitfalls & Complications

Infraspinatus tears → marked loss of active external rotation, detected with the lag sign.
Delayed diagnosis → chronic pain, weakness, and poor functional recovery.
Adhesive capsulitis (“frozen shoulder”) may develop if mobilisation is delayed.

🏥 Treatment in ED / MIU / UCC

Immobilise initially in a broad arm sling for comfort.
Encourage early, gentle active mobilisation (within days) to prevent stiffness.
Provide analgesia and safety-net advice.

📅 Follow-Up

👵 Elderly / low-demand / frail patients: Referral to physiotherapy via GP or on-site ED physiotherapist. Focus on rehabilitation rather than surgical repair.
💪 Young / active / high-demand patients: Urgent ultrasound scan (USS) to confirm diagnosis → rapid referral to fracture clinic or orthopaedics for possible surgical repair.

💡 Revision Pearls

🌟 Classic sign = painful arc + weakness on resisted abduction.
🧪 USS is quick, sensitive, and the usual first-line investigation in UK practice.
🚨 Missed tears in younger active patients → poorer surgical outcomes if delayed.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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