Pain at the side or top of the shoulder that worsens at night, weakness when lifting your arm, and difficulty with overhead activities are among the most common reasons patients in Bangalore seek a specialist shoulder opinion. In many cases, the underlying cause is a rotator cuff tear.
Dr. Kushalappa Subbiah is a fellowship-trained shoulder surgeon in Bangalore with specialist expertise in arthroscopic rotator cuff repair, offering patients a minimally invasive solution to one of the most prevalent shoulder injuries in adults.
What is Rotator Cuff?
The rotator cuff is a group of four muscles and their tendons that wrap around the top of the humerus, connecting the shoulder blade to the arm bone. These tendons stabilise the shoulder joint during movement and allow you to lift, rotate, and reach with your arm. The four muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis.
A rotator cuff tear occurs when one or more of these tendons is partially or completely torn away from its attachment on the humerus. The supraspinatus is the most commonly affected tendon. Tears range from small partial-thickness injuries to complete full-thickness ruptures where the tendon is entirely detached from the bone.
Types of Rotator Cuff
Causes
Degenerative wear over time is the most common cause, particularly in patients over 40 where the tendon tissue gradually weakens and becomes prone to tearing with normal activity. Acute trauma, such as a fall on an outstretched arm or a sudden forceful overhead movement, can cause tears at any age. Repetitive overhead activity in cricket, swimming, and racquet sports is a well-established contributing factor in younger athletes. Bone spurs beneath the acromion can also progressively abrade the tendon, leading to a degenerative tear over months to years.
- Shoulder pain at rest and at night, particularly when lying on the affected shoulder
- Weakness when lifting the arm sideways or rotating it outward
- Difficulty reaching overhead, behind the back, or across the body
- Pain that worsens with overhead activities such as throwing, swimming, or reaching for objects on a shelf
- A feeling of the shoulder giving way or lacking power during activity
- In complete tears: a dramatic reduction in shoulder strength with relatively less pain once the acute phase has settled
Diagnosis
Dr. Kushalappa performs a detailed clinical examination assessing shoulder strength, range of motion, and specific tendon function tests. The empty can test and drop arm test are particularly useful for identifying supraspinatus tears, while the lift-off test and belly press test assess subscapularis integrity.
MRI is the gold standard investigation, providing detailed information on the size, location, degree of retraction, and muscle quality of the tear. Ultrasound provides a useful dynamic assessment and is often used alongside MRI. This combined information is essential for surgical planning.
Treatment
Arthroscopic Rotator Cuff Repair
For partial tears with significant symptoms and all full-thickness tears in active patients, Dr. Kushalappa performs arthroscopic rotator cuff repair. Using keyhole incisions and an arthroscope, the torn tendon is mobilised, prepared, and reattached to its footprint on the humerus using small titanium or bioabsorbable suture anchors. The procedure is performed under general anaesthesia as a day case. The entirely arthroscopic approach means less post-operative pain, reduced infection risk, and faster recovery compared to open techniques. Recovery involves a sling for 4 to 6 weeks, with physiotherapy progressing over 3 to 6 months. Return to overhead activity and sport is typically at 6 months.
Why Choose Dr. Kushalappa Subbiah in Bangalore?
Dr. Kushalappa Subbiah completed a Fellowship in Shoulder Surgery at the Sydney Shoulder Research Institute, where he trained in advanced arthroscopic shoulder procedures including labral repair and reconstruction. He holds the International Olympic Committee (IOC) Diploma in Sports Medicine, and has direct clinical experience managing shoulder injuries in Indian athletes across cricket, swimming, tennis, and contact sports. He is appointed as a Consultant Shoulder Surgeon at NH Hospital, Bangalore.