ROTATOR CUFF INJURIES



24.06.22



By Free Motion Physiotherapy





What Is The Rotator Cuff?



The rotator cuff is a group of four muscles that come together as tendons to form a “cuff” or cover that surrounds the shoulder joint. The rotator cuff keeps the head of the upper arm bone (the humerus) firmly within the shallow socket of the shoulder.


The four muscles — supraspinatus, infraspinatus, subscapularis and teres minor — originate from the scapula (shoulder blade). The rotator cuff tendons attach to the head of the humerus in two bony spots.



What Does The Rotator Cuff Do?



The rotator cuff muscles help to keep the ball of the shoulder within the joint which provides stability and allows movement.


The rotator cuff muscles function as local mobilisers and support the larger shoulder muscles allowing you to raise your arm and rotate in all different directions.


A dysfunction in any of these four muscles will affect the stability and functioning of the shoulder.



What Causes A Rotator Cuff Tear?



Rotator cuff injuries are actually quite common, and their incidence increases with age. A rotator cuff tear may result from an acute injury, such as a fall or accident, or may be caused by normal age-related wear and tear with degeneration of the tendon. These injuries may also occur earlier in people who have jobs that require repeatedly performing overhead motions, such as painters and carpenters.


Risk Factors:

The following factors may increase the risk of having a rotator cuff injury:

• Age. The risk of a rotator cuff injury increases with age. Rotator cuff tears are more common in people older than 40.

• Poor Posture.

• Occupations. Jobs that require repetitive overhead arm motions, such as carpentry or house painting, can damage the rotator cuff over time.

• Certain sports. Some types of rotator cuff injuries are more common in people who participate in sports like tennis and weightlifting.

• Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.



What Are The Symptoms Of A Rotator Cuff Tear?



• The pain associated with a rotator cuff injury is often described as a dull ache deep in the shoulder.

• Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm.

• Pain may be present with overhead activities such as lifting or reaching (e.g., serving in tennis, painting a ceiling).

• You may have disturbed sleep and feel pain when you try to sleep on the affected side.

• You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back.

• Popping or clicking sounds or sensations may occur when moving your arm.

• If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.

• Some rotator cuff injuries don't cause pain.



What Are The Types Of Rotator Cuff Tears?



Types of torn rotator cuffs include:

• Partial: With an incomplete or partial tear, the tendon still somewhat attaches to the arm bone.

• Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. There’s a hole or rip in the tendon.



How Is A Rotator Cuff Tear Diagnosed?



Your healthcare provider will perform a physical examination to check for shoulder tenderness, range of motion and arm strength.


To confirm a diagnosis, you may get:

• An X-ray to check for arthritis or bone spurs.

• An MRI or ultrasound to look for tendon tears. Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.



The Management And Treatment Of Rotator Cuff Injuries What Are The Complications Of A Rotator Cuff Tear?



A rotator cuff tear without treatment, can extend or get larger over time. This can occur normally over time, or with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a relatively minor injury. This likely represents extension of an existing tear.


If you know you have a rotator cuff tear, worsening pain and decreasing strength may mean the tear is getting larger.


Without treatment, rotator cuff problems may lead to chronic shoulder pain, permanent loss of motion or weakness of the shoulder joint. A complete tear can make it almost impossible to move your arm.



Can A Rotator Cuff Tear Be Treated And Healed Without Surgery?



The majority of rotator cuff tears can be treated non-surgically using one or more of these treatments:

• Anti-inflammatory medications- NSAID’s to minimize pain & swelling

• Steroid (cortisone) injections- to ease pain & swelling

• An arm sling and rest- to give your shoulder time to heal. You may need to modify activities and stop certain work or sports for a period of time.

• Physiotherapy- for pain relief & rehabilitation.


The goals of treatment are to relieve pain, restore strength and gain range of motion to the involved shoulder.


Even though most tears cannot heal on their own, you can often decrease pain and achieve good function without surgery. Just because there is a tear, does not necessarily mean surgery is needed. About 8 out of 10 people with partial tears get better with non-surgical treatments.



At What Point Does A Rotator Cuff Tear Require Surgery To Fix It?



Surgery is recommended:

• If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication, rehabilitation and limited use of the arm.

• In active individuals who use the arm and shoulders for overhead work or sports. Weightlifters, swimmers, and tennis players are common examples.

• Your healthcare provider may recommend surgery for complete tears that are acute and due to a trauma.



How Important Is Rehabilitation In The Treatment Of A Rotator Cuff Tear?



Rehabilitation plays a critical role in both the non-surgical and surgical treatment of a rotator cuff tear.


When a tear occurs, there is frequent atrophy (weakness) of the muscles around the arm and loss of motion of the shoulder. Physiotherapy and an exercise program is necessary to regain strength and improve function in the shoulder.


Physiotherapy and exercises can improve the flexibility and strength of the muscles surrounding the shoulder joint. For many people with rotator cuff problems, this conservative treatment and exercises are all that is needed to manage their symptoms and recover.



After surgery, the repair must be protected from certain activities that may put healing at risk. As such, a physiotherapist can provide a safe and progressive treatment and exercise program.


Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed. Complete rehabilitation after surgery may take several months or even up to a year.



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