tay.generalcomments@nhs.scot

Rotator Cuff Tear

Symptoms and signs

  • Pain felt in anterior shoulder in C5 distribution/radiating to the arm
  • Limited active range of movement, specifically during abduction, passive movement greater than active movement
  • Sporadic worsening of pain, debilitation – injury or degeneration
  • Pain on overhead activities and/or abduction. Noticeable pain during rest
  • Pain at night with sleep loss
  • Weakness, that is not due to pain, usually in abduction or lateral rotation.
  • Atrophy of rotator cuff on looking at scapula musculature
  • More than 55 years old
  • Crackling sensations or soft tissue crepitus when moving the shoulder

Primary Care diagnostics

  • XR/USS

Useful resources

Patient Information leaflet– Rotator Cuff Tears

Initial management

  • Rule out traumatic injury to the shoulder
  • Pain control - Analgesia & NSAIDs as appropriate
  • Sub-acromial steroid injection by appropriately trained GP, FCP or MSK physiotherapist (Up to three)

Who to refer

Urgent referral for orthopaedic opinion:
  • Younger patient (under 70) with traumatic tear (perform x-ray of the injured shoulder (AP and Axial) to rule out fracture avulsions and request urgent USS.

Urgent referral for MSK physiotherapy 
  • Degenerative tears (over 70).  
Routine referral for orthopaedic opinion
  • Degenerative cuff tear (over 70) with failure to improve with Physiotherapy treatment. Please perform USS prior to referral to confirm extent of tear/other pathology (can be requested by MSK physio service).

How to refer

  • If under the care of the NHS MSK physiotherapy team, investigations and onward referral to UL service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention.
  • SCI gateway/Orthopaedic - Elbow and shoulder . Please note first of contact may be advanced practice Physiotherapist

Information to include when referring
  • Duration and any cause of symptoms, dominance, effect on ADL, work, hobbies
  • Indicate site/spread of pain and if pain constant or intermittent, and/or waking at night
  • Indicate ROM (active and passive) and weakness
  • Include treatment to date (injections/ physiotherapy)
  • XR /USS results (NB: RC tears findings on USS may be coincidental rather than causative)