Rotator Cuff Injury

What is the rotator cuff?

The rotator cuff is a group of four muscles that come together as tendons to form a “cuff” over the head of the humerus (upper arm bone). These muscles work together to stabilise the shoulder and keep the head of the humerus within the shoulder socket to allow movements of elevation and rotation.

The four muscles of the rotator cuff include:

·         Supraspinatus

·         Infraspinatus

·         Teres Minor

·         Subscapularis

Each muscle works independently. The most important and most vulnerable component of the rotator cuff is the supraspinatus tendon, which is essential for lifting the arm. The infraspinatus and teres minor rotate the arm outward, while the subscapularis rotates the arm inward.

 

What is a rotator cuff tear?

A rotator cuff tear occurs when one or more of the tendons in the rotator cuff are no longer fully attached to the bone. In many cases, torn tendons begin by fraying and as the damage progresses, the tendon can completely tear. Most tears occur in the supraspinatus tendon, however other areas of the rotator cuff may also be involved.

There are two different types of tears (degree of tear is diagnosed via ultrasound):

·         Partial tear:

Some of the tendon attachment has ruptured but some fibres remain attached to the bone

 

·         Full-thickness tear:

The tendon is no longer connected to the bone

How does a rotator cuff tear occur?

A rotator cuff tear is often the result of wear and tear from daily use. You’re more likely to have this if you have a job where you need to move your arm overhead repetitively, like a painter or a carpenter, or if you play overhead sports like tennis, cricket, swimming and baseball. An acute rotator cuff tear can also happen suddenly following a traumatic event such as falling on your arm or trying to lift something heavy.

Symptoms of a rotator cuff tear

Individuals with a rotator cuff tear may suffer from:

·         Severe pain at time of injury

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

·         Pain with overhead activities

·         Weakness when lifting or rotating your arm

·         Shoulder stiffness

 

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

Why is it important to see a physio?

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage as a rotator cuff tear can get larger over time. Additionally, early treatment can prevent your symptoms from getting worse and will allow you to get back to your normal routine much quicker.

 

What is the physiotherapy treatment?

Physiotherapy management consists of approximately three stages of recovery. The time frame of each stage greatly depends on an individual’s progress.

 

Phase 1 (increasing mobility):

·         Pain and inflammation management

·         Increase range of motion

·         Improve shoulder and thoracic posture

 

Phase 2 (increasing strength):

·         Improve flexibility and reduce tightness of the joint capsule

·         Improve strength of rotator cuff and surrounding muscles

 

Phase 3 (increasing shoulder function):

·         Increase shoulder girdle endurance and flexibility

·         Progress shoulder/scapular strength

·         Promote safe return to sport/activity

 

How long will it take me to recover?

Return to normal function depends upon the severity of the rotator cuff tear, the rate of recovery and the level of activity you wish to return to. A typical rotator cuff tear patient will return to full use of their arm within 6 to 8 weeks.

What other treatment options are available?

Corticosteroid injection

·         If pain persists, a corticosteroid injection may be considered

·         Corticosteroids are very strong anti-inflammatories that relieve pain and inflammation

·         They are associated with a poorer long-term effect on reduction in pain and repeated corticosteroid injections are discouraged as it can weaken the muscles of the rotator cuff

Surgery

Your doctor may recommend surgery if your pain does not improve with nonsurgical methods.

Signs that surgery may be a good option for you include:

-          Your symptoms have lasted 6 to 12 months

-          You have a large tear (more than 3 cm) and the quality of the surrounding tissue is good

-          You have significant weakness and loss of function in your shoulder

-          Your tear was caused by a recent, acute injury

 

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears, including traditional open repairs, arthroscopic repairs and mini-open repairs.

Physiotherapy will still be required post-surgery and most patients regain full range of motion and adequate strength by 4 to 6 months after surgery

References:

1.        Edwards, P., Ebert, J., Joss, B., Bhabra, G., Ackland, T., Wang, A. (2016). Exercise rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. Int J Sports Phys Ther, 11(2): 279-301

2.        Gialanella, B., Prometti, P. (2011). Effects of Corticosteroids Injection in Rotator Cuff Tears. Pain Medicine, 12(10): 1559-1565

3.        Hwang, K. S., Kim, M.J., Lim, J.Y., Lee, W.H., Choi, J.E. (2018). Systematic review with network meta-analysis pf randomised controlled trials of rotator cuff tear treatment. International Journal of Technology Assessment in Health Care, 34(1): 78-86

4.        Simons, S.M., Roberts, M. (2017). Patient Education: Rotator Cuff Tendonitis and Tear (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/rotator-cuff-tendinitis-and-tear-beyond-the-basics?search=rotator%20cuff%20tear&source=search_result&selectedTitle=3~35&usage_type=default&display_rank=3#H2

5.        Martin S.D., Martin, T.L. (2017). Management of Rotator Cuff Tears. Retrieved from https://www.uptodate.com/contents/management-of-rotator-cuff-tears?search=rotator%20cuff%20tear&source=search_result&selectedTitle=1~34&usage_type=default&display_rank=1#H4

6.        Brunker, P., Clarsen, B., Cook, J., Cools, A., Crossley, K., Hutchinson, M. … Khan, K. (2017). Brunker and Khan’s clinical sports medicine: Injuries (5th ed). Australia: McGraw-Hill Education.

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