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Injury Prevention

All the information on here is available on any good website and you should always go to see your doctor

What is the rotator cuff?

The rotator cuff is a group of four muscles that are positioned around the shoulder joint. The muscles are named:

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres minor

The rotator cuff muscles work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon. This tendon attaches to the head of the humerus (the bony surface at the top of the upper arm bone). There is a space underneath the acromion of the scapula, called the subacromial space. The rotator cuff tendon passes through here.

What is the prognosis (outlook) for rotator injuries

If rotator cuff tendonitis is adequately treated, there can be complete recovery.

If treatment of any rotator cuff problem is delayed or inadequate, it can lead to the affected person being cautious about moving their shoulder because of pain. This means that the shoulder can stiffen up and can lead to adhesive capsulitis (frozen shoulder). See separate leaflet called Frozen Shoulder 

The treatment for rotator cuff impingement syndrome is similar to that for rotator cuff tendonitis. You should rest from any activity that involves repetitive movement of the shoulder. This particularly includes overhead activity such as that performed by plasterers or painters and decorators. This may mean that you have to modify or change your work activities. However, be careful to keep your shoulder mobile so that it does not stiffen up. Painkillers, anti-inflammatories, physiotherapy and steroid injections can help.

If these treatments do not work, some people with rotator cuff impingement syndrome need to have an operation to widen the subacromial space. This is usually referred to as a decompression operationThe natural history of rotator cuff disease is poorly understood. In some people a rotator cuff impingement syndrome may lead to excessive wear and tear of the rotator cuff tendon. This in turn may lead to weakening of the tendon and the tendon may tear. But, it is not known how many people with impingement develop a cuff tear.

Rotator cuff tears are usually tears in the rotator cuff tendon rather than in the muscles themselves. In younger people, a rotator cuff tear normally happens as a result of trauma (injury) due to a fall or accident. In older people, they are often caused by rotator cuff impingement syndrome (see above).

Rotator cuff tears can be minor/partial or full/complete depending on the degree of damage to the tendon.Pain is the most common symptom of a rotator cuff tear. The pain tends to be over the front and outer part of the shoulder. It is worse when your shoulder is moved in certain positions. For example, when your arm is moved above your head on dressing or combing your hair, or moved forwards to reach for something.

Your shoulder or arm can also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching when they move their shoulder.




Tendon ruptures can usually be diagnosed by clinical assessment. X-rays and ultrasound are used to establish or confirm the diagnosis but MRI gives the most definitive information about the nature and extent of the rupture. Tendon ruptures are uncommon but may cause severe initial pain and lead to permanent disability if untreated. Management may be surgical or non-surgical depending on the site and severity of the rupture, and the clinical features and disability caused by the rupture.
Tendon damage (including rupture) has been reported rarely in patients receiving quinolones (eg ciprofloxacin, ofloxacin, levofloxacin).[1] Tendon rupture may occur within 48 hours of starting treatment but have also been reported several months after stopping a quinolone. The risk of tendon damage is increased by the concomitant use of corticosteroids. Quinolones are therefore contra-indicated in patients with a history of tendon disorders related to quinolone use. If tendinitis is suspected, the quinolone should be discontinued immediately.

The most common tendon ruptures are discussed below. Achilles Tendonitis and Rupture are discussed in greater detail in a separate article. Shoulder rotator cuff tears are discussed in the separate article Shoulder Pain.

Ruptures of the proximal biceps tendon make up nearly all biceps ruptures.[2] Proximal biceps tendon rupture is usually transverse and either within the shoulder joint or within the proximal part of the intertubercular groove. The prognosis for biceps tendon ruptures is good for both surgical repair and for conservative management.[2]


The biceps muscle bunches up in the distal arm, causing the characteristic 'Popeye muscle' appearance. There is minimal loss of function


  • Patients can be treated conservatively, as most will become asymptomatic after 4-6 weeks. Patients can benefit from non-steroidal anti-inflammatory drugs and physiotherapy.
  • There are no generally agreed guidelines for the role of surgical repair, but tenodesis and proximal subacromial decompression (or distal reattachment) may be required for young or athletic patients, or for persons who require maximum supination strength.[2]                                                                                                                   DISTAL BICEP TENDON RUPTUNE
  • Distal biceps tendon rupture is usually caused by a single traumatic event involving flexion against resistance, with the elbow at a right angle.
  • Incidence of distal biceps rupture is 1.2 per 100,000 per year.[3]
  • It most often occurs in a 50-60 year-old active male.                                                                  
  • A sudden sharp tearing sensation results in a painful swollen elbow with weakness of flexion and supination.
  • In a partial rupture, the biceps tendon will still be palpable in the antecubitManagement[3]
  • Conservative treatment results in persistent elbow weakness, especially supination, and patients may experience prolonged pain.
  • Surgery must be performed early in order to avoid scarring of the biceps. With delayed treatment, the biceps may be attached to the brachialis.



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