Managing a Rotator Cuff Tear: A Basic Guide and How Physiotherapy Can Help

Have you ever experienced a nagging pain in your shoulder that just won’t go away? It could be a rotator cuff tear, a potential cause of shoulder pain. But don’t worry, we’re here to help you understand what’s going on and how to deal with it.

What is a Rotator Cuff Tear?

The shoulder joint, anatomically referred to as the glenohumeral joint, is a ball and socket joint built for mobility rather than stability. Imagine a golf ball (the upper arm) sitting on a tee (the shoulder socket). Stability and control of the glenohumeral joint comes from the connective tissue and muscles surrounding the joint. 

The Glenohumeral Joint (InjuryMap, CC BY-SA 4.0, via Wikimedia Commons)

The rotator cuff is a crucial component that keeps it running smoothly and in a controlled manner. The rotator cuff is a group of muscles that attach to the shoulder blade and encircle the upper arm bone, providing stability and preventing it from colliding with the shoulder bone. These muscles raise, lower, and rotate the arm within the shoulder socket while maintaining stability. The rotator cuff includes the subscapularis, infraspinatus, supraspinatus, and teres major muscles. 

The rotator cuff muscles (InjuryMap, CC BY-SA 4.0, via Wikimedia Commons)

A rotator cuff tear, as the name suggests, is when one or more of these muscles or tendons get torn. This can be a partial tear, where the tendon is not completely severed, much like a frayed rope. On the other hand, a full tear is like a snapped rope, where the tendon is fully disrupted. Both types can cause significant discomfort and limit your shoulder’s function.

Why Does it Happen?

Rotator cuff tears are commonly caused by a combination of factors. Overuse or repetitive motions involving the shoulder, such as lifting heavy objects or engaging in sports like tennis or baseball, can gradually wear down the tendons of the rotator cuff, leading to tears. Additionally, the natural aging process can contribute to the development of these tears, as the tendons become less flexible and more prone to injury. Sudden traumatic events, such as a fall or a direct blow to the shoulder, can also result in rotator cuff tears. They can even happen as part of the normal aging process.

In one study examining the prevalence of rotator cuff tears in the general population, 22.1% of subjects (147 out of 664 individuals) had a full-thickness rotator cuff tear. The prevalence of rotator cuff tears increased with age. Rotator cuff tears were found in 11% of the 50-59 age range, 15% in the 60-69 age range, 27% in the 70-79 age range, and 37% in the 80-87 age range. This increase may be due to a decline in the strength and function of the rotator cuff muscles of older individuals. Older populations also tend to experience larger tears in the rotator cuff.

The study also revealed that the rate of asymptomatic tears were almost double those that were symptomatic – 35% of the tears were symptomatic, while the remaining 65% were asymptomatic. An asymptomatic rotator cuff tear can be described as a situation where the body adjusts to the tear in the rotator cuff by employing compensatory mechanisms. Rotator cuff tears may be asymptomatic if the size of the tear remains the same, while they seem to be symptomatic when a new tear or enlargement of the size of the existing tear occurs.

What Does a Rotator Cuff Tear Feel Like?

Whether it’s a partial or complete tear, you might experience similar symptoms. You could feel pain when you move your shoulder or even when you’re resting, especially at night. You might also notice swelling, tenderness, and a decrease in your shoulder’s range of motion and strength. More significant tears will generally be accompanied with significant weakness and an inability to elevate the arm. 

Diagnostic Imaging and Rotator Cuff tears

Diagnostic imaging techniques, such as ultrasound and MRI, are valuable in detecting rotator cuff tears by providing detailed visual information. However, it is important to note that imaging findings alone may not always reflect the presence or absence of symptoms, and severity of symptoms may not match with imaging. Clinical findings, including physical examination and patient-reported symptoms, are essential in making an accurate diagnosis. Integrating imaging and clinical findings allows healthcare professionals to develop treatment plans that address the individual needs of each patient. The ultimate goal is to alleviate pain, restore function, and improve the quality of life for individuals with rotator cuff tears.

How Can Physiotherapy Help?

A personalized physiotherapy approach to treating a rotator cuff tear should consider factors like your age, activity level, and personal goals. A physiotherapist can help modify your activities to prevent further injury, manage your pain, and restore your shoulder’s range of motion and strength.

What Does Treatment Look Like?

Treatment typically involves  a combination of exercises designed to restore your shoulder’s range of motion and increase its stability, such as dynamic stabilization exercises that challenge muscle strength, positioning and coordination. Additionally, manual therapy techniques, which could involve hands-on adjustments to your shoulder, are often employed to help alleviate pain and speed up recovery.

Living with a rotator cuff tear can be challenging, but with the right guidance and treatment, you can get back to doing the things you love. At Connect Physiotherapy & Exercise in Edmonton, we’re committed to helping you navigate the road to recovery. Don’t let shoulder pain steer your life off course – reach out to us today.

Remember, while knowledge is power, self-diagnosis and treatment can be risky. While this blog provides useful information, it’s essential to see a trained professional for proper diagnosis and management. Every person is unique, and so is their recovery journey.

References

Itoi, E. (2013). Rotator Cuff Tear: Physical Examination and Conservative Treatment. Journal of Orthopedic Science, 18: 197-204.

Malango, G.A. (2012, June). Rotator Cuff Injury. Retrieved from http://emedicine.medscape.com/article/92814-overview.

Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N., Kikuchi, K., Kijima, H., & Itoi, E. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of orthopaedics, 10(1), 8–12.

Yamamoto A, Takagishi K, Kobayashi T, et al. Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg 2011;20:1133–7.

Yamamoto A, Takagishi K, Shitara H, et al. Longitudinal study for rotator cuff tears in the general population (abstract). J Shoulder and Elbow Surgery 2015;24:e347.