Rotator cuff tears
A common injury, which sounds scary – anytime a ‘tear’ is diagnosed it always leads us to thinking the worst! Thankfully, in the majority of cases, a rotator cuff tear can be treated quickly and conservatively with the right approach.
The rotator cuff is made up of 4 muscles which help to move the arm, but more importantly keep the humerus tightly in the socket of the scapula throughout the large range of movement the shoulder has.
Unfortunately, this large degree of movement coupled with the fact the tendons of the rotator cuff muscles have areas of very low blood supply make the area susceptible to injury and degeneration over time – making the risk of a tear more likely as we age.
Also, stresses we put through our shoulders from sports, training and occupations have a big impact, with repeated overhead movements – throwing, painting and decorating, weights – all increasing the risks of tears, especially if the mechanics of the whole shoulder are not working optimally.
The actual rotator cuff tears can come in all shapes and sizes, ranging from a mild partial-thickness tear (not all the way through the tendon) to a large full-thickness tear (all the way through the tendon) to a full rupture, where the tendon has been completely torn in two.
However, it is not all ‘doom and gloom’ with rotator cuff tears with research showing that many people having tears, but not having any symptoms – so no pain, weakness or dysfunction in the area, even though a tear is present.
Thankfully, the majority of tears, ranging from small to large and partial- to full-thickness, can be treated conservatively with physiotherapy. The key is to make sure the whole mechanics of the shoulder girdle are assessed for weaknesses and dysfunctions and any issues addressed. This takes pressure off the torn area, allowing any inflammation to subside and the pain and dysfunction to improve.
Although the majority respond positively to this approach, it does not work for everybody, with some people still requiring a surgical repair. However, it is still positive to have gone through an assessment and treatment programme as it allows for a stronger base for recovery after the surgery – a sort of ‘prehabilitation’ making the surgery and rehabilitation more successful.
For full ruptures, surgery is generally the first option to reattach the tendons – but this is not always possible, depending on the level of degeneration present and whether the remaining tissue would be capable of tolerating the reattachment.
In these cases, to keep people active and their shoulders functioning, it all comes down to getting other muscles to take over - which in some cases can be very successful. I once had a gentleman in his 70s with two full rotator cuff muscle ruptures alongside a long head of bi-ceps rupture, but thankfully was able to keep him playing badminton on a weekly basis - so plenty can still be achieved, even in these cases.
If you, or anyone you know, has shoulder pain or a rotator cuff tear get in touch with Piece by Piece Physiotherapy to see how we can help.