What is the Rotator Cuff?

The rotator cuff is a collection of tendons and muscles fused to a capsule. As a group, this structure provides stability to the shoulder throughout its range of motion. Tears in these tendons are common, especially with age, but most tears are painless. However, some tears can lead to a painful and even debilitating status. There are two ways in which a rotator cuff can tear.

The Two Ways a Rotator Cuff Can Tear

1. A sudden acute tear can occur with sufficient trauma such as falling down with your arm outstretched. Acute tears can also occur when people try to lift something heavy with a sudden, jerking motion. In these cases, the pain is usually intense at the time of injury. Immediate shoulder or arm weakness is common. You may feel a snapping sensation when trying to move the arm.
2. Chronic tearing can occur slowly over time. The likelihood of chronic tearing increases when there is also chronic tendinosis or shoulder impingement. Sports activities that can result in chronic tearing include baseball, tennis, rowing, and weightlifting. Many jobs, including household activities, can also put this type of strain on the rotator cuff. You often won’t notice when this type of tearing begins. Symptoms of pain, stiffness, weakness, and loss of motion worsen slowly over time.

Characteristics of Rotator Cuff Pain (Worse at Night)

With rotator cuff tears, pain is often worse at night. The pain can wake a person. The pain during the day is often more tolerable, but it can be aggravated by specific activities.

Two Categories of Rotator Cuff Tears

1. A complete, full-thickness tear in which the tear goes all the way through the tendon. This type of tear does not heal on its own.
2. A partial tear means the tendon has torn, but the tendon is still managing an attachment between the bone and muscle.

Which Rotator Cuff Tears Should be Treated with Physiotherapy?

Surgery followed by physiotherapy is always an option to repair rotator cuff tears, but many have high success rates with physiotherapy alone. Non-traumatic tears do well in physiotherapy. One study measured an 84% success rate (no surgery needed) compared to a 16% success rate with traumatic rotator cuff tears. Also, most tears of less than 50% thickness can be treated successfully with physiotherapy alone (65%). However, it has also been noted that delaying surgery of partial-thickness tears for a course of physiotherapy improves the functional results of surgery at six months. By this standard, most partial-thickness tears could benefit from physiotherapy first.

Physiotherapy Treatment for Rotator Cuff Tears

Call for an appointment at Advanced Physiotherapy if you have ongoing problems. Conservative management will usually include:

• Activity modification
• Manual therapy: Targeted mobilisation of the joint can often help in restoring normal function and settling the symptoms.
• Range of motion exercises
• Targeted strengthening
• Medication: In some cases, medication can progress the rehabilitation and healing process. We will work with your medical doctor to provide a complete solution.

In cases that prove refractory to conservative care or when there is a massive tear, surgery may be indicated.

 

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