What is a Rotator Cuff Tear?
A rotator cuff tear is merely a tear within your shoulder’s rotator cuff tendons. A rotator cuff tear can occur in two ways:
- trauma, and
- repeated microtrauma.
Traumatic rotator cuff tears occur quickly or under heavy load, e.g. a fall or lifting a heavyweight. However, the most common cause of a rotator cuff tear is repeated microtrauma, which can occur over several weeks months or years.
Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft tissue resulting in bruising or swelling. Since only a few millimetres are separating your rotator cuff tendons from a bony hood (acromion), the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons.
What are the Symptoms of a Rotator Cuff Tear?
Your rotator cuff tears may be partial or full-thickness tears. You will notice that your shoulder pain and weakness increases with the severity of your rotator cuff tear. More importantly, it is a reduction in your shoulder function that is important.
Partial rotator cuff tear may only present with mild shoulder pain, clicking during shoulder elevation and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back.
Full-thickness rotator cuff tear will typically present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases, the rotator cuff tear is so severe that a significant number of your pain fibres torn, which can make them less painful but very weak.
When you have a small rotator cuff tear, you can often still raise your arm with or without pain. Moderate tears are usually very painful, and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a massive rotator cuff tear occurs, you may find that you are unable to lift your arm at all.
What is the Rotator Cuff?
Your shoulder’s rotator cuff is a major group of four small shoulder muscles that stabilise, control and move your shoulder joint. When your rotator cuff muscles work in isolation, they exhibit rotational motion at the glenohumeral (shoulder) joint, which is why we describe them as the rotator cuff. The four muscles collectively known as the rotator cuff are your subscapularis, supraspinatus, infraspinatus and teres minor muscles.
How is a Rotator Cuff Tear Diagnosed?
Your physiotherapist or sports doctor will suspect a rotator cuff tear based on your clinical history and the findings from a series of clinical tests.
A diagnostic ultrasound scan is the most accurate method to diagnose the size and location of your rotator cuff tear. MRI’s may show a rotator cuff tear but have also missed a tear. X-rays are of little diagnostic value when a rotator cuff tear is suspected.
For specific advice regarding your rotator cuff tear, please consult your trusted shoulder physiotherapist or doctor.
What is the Best Treatment for Rotator Cuff Injury?
Small and medium-sized rotator cuff tears usually heal successfully with appropriate conservative management and rotator cuff physiotherapy treatment. Physiotherapy often is one of the first treatment options suggested by your doctor or shoulder specialist.
If conservative treatment methods have failed to settle your symptoms, or you have an added shoulder bursitis, your health professional may recommend a corticosteroid injection. These injections may improve your pain while sleeping or allow you to perform your rotator cuff exercises. Corticosteroid injections are known to weaken your tendons potentially, so the prescription of a dose will be informed.
Unfortunately, more massive rotator cuff tears may require rotator cuff surgery (arthroscopic or open) if physiotherapy treatment fails to assist. Massive rotator cuff tears may require shoulder replacement or reverse shoulder arthroplasty to restore some of your shoulder function. Post-operative physiotherapist guided rehabilitation will be necessary to regain your shoulder function safely.
Early rotator cuff tear treatment is essential. Delay will result in retraction of your rotator cuff tendon, which can make healing or rotator cuff repair surgery more difficult and less successful. The best rotator cuff tear results occur when the rotator cuff injury is fresh.
Rotator Cuff Tear Treatment
Rotator cuff tears are a common problem. Rotator cuff injury deteriorates further if you return to sport or work too quickly – especially if you didn’t complete a thorough rehabilitation program. They are also regularly poorly treated by inexperienced shoulder practitioners.
Your rotator cuff is an essential group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents other shoulder injuries such as rotator cuff impingement or shoulder dislocation.
Researchers have concluded that there are mostly seven stages that need to be covered to rehabilitate rotator cuff tears and prevent recurrence effectively.
- Early Injury Protection: Pain Relief & Anti-inflammatory Tips
- Regain Full Shoulder Range of Motion
- Restore Scapular Control
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception & Agility
- Return to Sport or Work
Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work.
The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
There is no specific time frame for when to progress from each rotator cuff treatment stage to the next. Many factors will determine your rotator cuff rehabilitation status during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that your physiotherapist must supervise your progression as attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your rotator cuff injury, please contact your shoulder physiotherapist.
What about a Corticosteroid Injections?
Corticosteroid injections may relieve pain and promote tendon healing. Cortisone’s primary function is to increase blood sugar, suppress your immune system, and aid in fat, protein and carbohydrate metabolism.
There are side effects, and corticosteroid injections should be used cautiously, especially with diabetics. It also decreases bone formation and leaves you vulnerable to future tendon rupture.
Researchers generally find that there is a good short-term benefit from corticosteroids, but there are some long-term side effects, which may be less desirable. Some patients report good initial relief before a recurrence of symptoms. As with all medications, please discuss with your doctor regarding the pros and cons of a corticosteroid injection.
Rotator Cuff Repair Surgery
Rotator cuff repair surgery for full-thickness and partial-thickness tears that do not heal with physiotherapy is an option. Most shoulder surgeons will recommend at least six weeks of physiotherapy before contemplating rotator cuff repair surgery.
Post-operative physiotherapy rehabilitation is comprehensive and regular for your best outcome. Your post-operative rotator cuff repair recovery commonly takes between six to twelve months.
During rotator cuff repair surgery, your surgeon will attempt to sew your torn tendon back together. The best results occur when the tear is fresh rather than older damage.
Most rotator cuff repairs take approximately six months of rehabilitation to regain as full as possible range of motion, shoulder strength and function.
It is essential to follow your physiotherapist’s exercise prescription and surgeon’s post-operative advice. In our experience, about 90% have an excellent outcome at 12 months postoperatively.
As with all surgery, there are associated risks or complications. These can include infection, stiffness, blood clot formation, and nerve injury. The dangers of significant joint stiffness are less than 5%, and the risk of nerve injury is low – approximately 1 in 10000.
Shoulder Replacement Surgery
Some massive rotator cuff tears will be irreparable using a routine rotator cuff repair. In these instances, a total shoulder replacement is an option for you and your surgeon.
Please seek your trusted shoulder physiotherapist or doctor for their specific advice.
Common Shoulder Pain & Injury Conditions
- Rotator Cuff Syndrome
- Shoulder Tendinopathy
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Shoulder Impingement
- Swimmer's Shoulder
- Subacromial Decompression
- Shoulder Arthroscopy
- Rotator Cuff Repair
- SLAP Repair
- Biceps Tenodesis
- Biceps Tenotomy
- Total Shoulder Replacement
Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.
If shoulder surgery is required, then your physiotherapist may undertake:
Pre-operative rehabilitation - to either trial a non-operative/conservative treatment approach or to condition and prepare your shoulder and body for a surgical procedure.
Post-operative physiotherapy - to safely and methodically regain your normal range of movement, strength, speed and function.
PhysioWorks physiotherapists have a special interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you attaining the best possible outcome for your shoulder injury.
For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.