Rotator Cuff Tear and Rehabilitation

What is it?

Rotator cuff Injury of the shoulder is a very common condition involving the tendons of the rotator cuff. The rotator cuff is made up of 4 muscles that function to hold the arm into the shoulder socket. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus.

In most rotator cuff tears, the tendon is torn away from the bone. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object. There are different types of tears.

Partial tear. This type of tear is also called an incomplete tear. It damages the tendon, but does not completely sever it.

Full-thickness tear. This type of tear is also called a complete tear. It separates all of the tendon from the bone. With a full-thickness tear, there is basically a hole in the tendon.

The most common symptoms of a rotator cuff tear include:

• Pain at rest and at night, particularly if lying on the affected shoulder

• Pain when lifting and lowering your arm or with specific movements

• Weakness when lifting or rotating your arm

• Crepitus or crackling sensation when moving your shoulder in certain positions

Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.

Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as voltaren or ibuprofen, may relieve the pain at first.

Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.

It should be noted that some rotator cuff tears are not painful. These tears, however, may still result in arm weakness and other symptoms.

Mechanism of Injury

There are two main causes of rotator cuff tears: injury and degeneration.

 Acute Tear

If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear

Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater likelihood of a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

Several factors contribute to degenerative, or chronic, rotator cuff tears.

• Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.

• Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.

• Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.

Common Management Techniques

• Avoidance of any activities that cause pain in the shoulder.

• Improvement of shoulder mechanics to prevent further impingement of tendon. This may include: 

  • • Massage and stretching 

    • Strengthening of weak muscles

    • Activities to Change your pattern of movement 

• Use of anti-inflammatory tablets or steroid injections. 

• In severe cases, surgery may be necessary to repair tears and/or decompress the tendons. 

• Physiotherapy treatment will assist recovery and may consist of:

  • • Joint movement

    • Soft tissue massage

    • Posture correction

    • Taping 

    • Strengthening and stretching exercises

    • Planning return to work/sport programs 

Initially the pain may worsen with treatment due to the inflammatory nature of the injury.

Prognosis

Recovery will depend on age, the severity of the tear, necessity for surgery, and the patient’s response to treatments. These injuries are slow to heal with recovery time ranging from 6 weeks to 12 months. 

To avoid recurrence a home exercise program, to build adequate strength, is an essential component of your rehabilitation. 

For more information feel free to ask your Physiotherapist. 

​Make an appointment asap with our experienced Physiotherapist Kirsty for your initial assessment and action plan to get your shoulder fixed.