Rotator cuff tear in the shoulder

What is a rotator cuff tear?

It is a partial or complete tear of one or more tendons in the shoulder.

‍

What is the rotator cuff of the shoulder?

It is the grouping of the tendons of four shoulder muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. These four muscles play an important role in shoulder stability. The muscles must coordinate well to allow the shoulder to make healthy movements.

‍

What is a tendon?

A tendon is the structure that attaches the muscle to the bone. When a muscle contracts, the force is transmitted to the tendon, and the tendon stiffens to move the bones.

‍

What are the causes of a rotator cuff tear?

There can be two types of causes that lead to a rotator cuff tear:

• A degenerative tear: the tendon tears gradually over several years due to progressive wear and tear. There is no specific accident. This is very similar to a rotator cuff tendinopathy (see the corresponding section), and often the two can be present at the same time.
• A traumatic tear: the tendon tears suddenly during a specific accident.

‍

A traumatic tear can occur due to different types of accidents such as:

• A fall on the shoulder
• Lifting a heavy load
• The shoulder undergoes an extreme movement

‍

What are the symptoms of a rotator cuff tear?

It's important to know that not all rotator cuff tears cause pain. Many people have tears in their rotator cuff without ever experiencing any issues. Here are some statistics to illustrate this:

• 50% of people aged 60 and over who have no shoulder pain have rotator cuff tears on MRI (magnetic resonance imaging).
• 40% of professional baseball pitchers have partial or complete rotator cuff tears without any pain while playing. They even remained pain-free in the five years after this study.

‍

When symptoms are present, here are the most common ones:

• Shoulder pain that has appeared gradually (degenerative tear) or suddenly after a specific event (traumatic tear)
• Shoulder weakness and pain when lifting loads
• Significant decrease in the strength of our shoulder compared to usual or compared to the other side
• Shoulder pain when raising your arms in the air

‍

How is a rotator cuff tear diagnosed?

Diagnosis is possible with a review of your symptoms and a clinical examination. Sometimes, an ultrasound or MRI (magnetic resonance imaging) will be requested to determine which tendon is injured. This is especially useful when a doctor is considering surgery. When the tear is degenerative, medical imaging is rarely useful to guide treatment.

‍

When should you consult a physiotherapist for a rotator cuff tear?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

‍

If you've had an accident that caused your pain, you should quickly consult a physiotherapist who can guide you towards the best course of action.

‍

« If you are waiting for surgery to repair your rotator cuff, doing physiotherapy while waiting for your surgery improves healing after the surgery. Therefore, you should get a head start and consult a physiotherapist. »

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

‍

What are the physiotherapy treatments for a rotator cuff tear?

Your physiotherapist will perform an assessment to determine the cause of the pain and limitations by evaluating the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

‍

Based on the assessment results, your physiotherapist will:

• Mobilize your shoulder to reduce pain and improve your range of motion.
• will provide specific exercises to increase shoulder mobility, reduce pain, and improve control of your movements and muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

‍

What to do at home for a TRAUMATIC rotator cuff tear?

As with any traumatic injury, you should follow the PEACE and LOVE principles. Read the blog post on PEACE and LOVE (coming soon) and then read here for advice that applies to rotator cuff tears in the shoulder.

(make sure you have read the blog post that explains the PEACE and LOVE steps in detail)

‍

For P = Protection

You can use a triangular bandage to support your arm for 24-48 hours to reduce pain.

‍

For C = Compression

It is not necessary to compress the shoulder.

‍

For L = Load:

Start moving the injured shoulder again and using that arm for your daily tasks without significantly increasing the pain. Do the dishes, pick up lighter objects with the injured side, etc.

‍

For V = Vascularisation:

Light to moderate cardio exercise, done without pain, speeds up healing. Therefore, for a rotator cuff tear, you can:

• Walking
• Use a stationary bike with your arm well supported
• Do aquajogging
• Use an elliptical machine without using your arms

‍

Here are some other tips that may help at home:

• Support your arm with a cushion under your armpit, an armrest, or by putting your hand in your pants pocket to elevate your shoulder.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck. Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.
• Avoid sleeping on the painful shoulder.
• If you can't find a comfortable position for the night, use one or two pillows to support your arm.

‍

Did you know?

• For rotator cuff tears in the shoulder, physiotherapy is as effective as surgery.

‍

Sources:

Cook C, Orthopedic Physical Examination Tests, an evidence based approach . 2008

Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE.

‍