Rotator Cuff Tear
Rotator Cuff Tear
Acute Traumatic Rotator Cuff Tear
Degenerative Rotator Cuff Tears
Referral Criteria
Red Flags
Acute Traumatic Rotator Cuff Tear
Trauma associated Shoulder pain with:
Symptoms and signs suggestive of a complete rotator cuff tear
These may include:
Significant loss of overhead function and/or weakness of external rotation, however some patients may still maintain overhead function
Arrange an urgent USS and urgent orthopaedic referral
Degenerative Rotator Cuff Tears
Symptoms and signs suggestive of a rotator cuff tear with/without pain
May settle with conservative measures:
- Analgesia
- Activity modification
- Physiotherapy
- Consider Musculoskeletal Interface Service
NB. Partial thickness tears can be found incidentally on MRI scanning and may not be the source of pain, however tears causing pain and disability require treatment
Degenerative Rotator Cuff Tear Referral Criteria
Symptoms and signs suggestive of a rotator cuff tear without history of trauma with
Significant pain and disability with significant impact on activities of daily living or employment
OR
Infraspinatus tears (Identified by a loss of active external rotation) Requires urgent referral
AND the patient is willing to consider surgery
Shoulder X ray within 6 months is required for the referral
Discussion Points
Repair of the rotator cuff is not always appropriate in older patients and each patient must be considered individually. Without careful management however, untreated tears can progress to leave the patient with no useful function or painful erosion of the shoulder.
Patients over 65 with a tear who are pain free and function normally above shoulder height need no further intervention. Other patients need careful counselling as to their options.
Red Flags
Same day referral
Unreduced dislocation Refer to ED
Septic joint Discuss with on call orthopaedics
Urgent referral
Acute traumatic rotator cuff tear
Cancer
Suspected primary bone/soft tissue tumour 2WW
Metastasis of suspected primary site but not confirmed 2WW
Metastasis of unknown primary site, active treatment Cancer MDT Co-ordinator
Metastasis of unknown primary site Urgent oncology
Suspected inflammatory oligo/polyarthritis
Martin SD, Martin TL. Management of Rotator Cuff Tears. Up to Date October 2017
Contributors
Mr Jeremy Dainton, Consultant Orthopaedic Surgeon, Royal Cornwall Hospitals NHS Trust
Mr Sean Dixon, Consultant Orthopaedic Surgeon, Royal Cornwall Hospitals NHS Trust
Annie Rae, Specialist Extended Scope Physiotherapist, Royal Cornwall Hospitals NHS Trust
Deanne De Beer, Specialist Extended Scope Physiotherapist, Royal Cornwall Hospitals NHS Trust
Dr Katy Bray, GP with Specialist Interest Orthopaedics, Three Spires Medical Practice
Dr Rebecca Hopkins, GP and RMS Orthopaedic Guidelines Lead, Kernow Referral Management Service
Date reviewed 11/03/2022
Next review due 11/03/2023
Sifter name Dr Rebecca Hopkins
Version 1.1