Rotator Cuff Tears
A rotator cuff tear is a tear to one of the four muscles of the rotator cuff.
The four muscles that comprise the rotator cuff are:
- The supraspinatus.
- The infraspinatus.
- The subscapularis.
- The teres minor.
These tears can either occur gradually with degeneration of the muscles/tendons or from an acute incident such as falling over or lifting something heavy. Typically these tears occur as you become older as your body’s ability to heal itself decreases. Often a rotator cuff tear will follow other conditions such as primary or secondary impingement or tedinopathies, which weakened the tendons.
A tear will normally occur after the rotator cuff has been fatigued. This fatigue can occur from a heavy session at the gym, shifting furniture around your home or from something as simple as cleaning the windows. As the rotator cuff fatigues the dynamics of the shoulder become worse. This loads the rotator cuff even more increasing the risk of impingement and rotator cuff tears. A fatigued muscle will be more susceptible to injury as it will be unable to generate the forces to resist the pull from heavy loads. This is why the majority of rotator cuff tears occur at the end of a day when you are already fatigued. The other common time to injure your rotator cuff is at the start of your shift or session when you have failed to warm up adequately.
Tears most often occur in the tendon or at the musculotendinous junction (where the muscle and the tendon join). This is because the tendon has a relatively poor blood supply, causing a decreased recovery time and making it susceptible to repetitive trauma.
Tears occur in a range of grades:
Grade 1 strain:
- Stretching of some fibres beyond it capabilities. You will have some discomfort and limitations. Recovery period is up to a couple of weeks.
Grade 2 strain:
- Damage to a moderate number of fibres, will generally be rather painful. Initially the shoulder will be very restricted but will improved with time. Recovery will generally take from weeks to several months depending on the seriousness of the condition. Large unresponsive tears may be suitable for surgery.
Grade 3 tear:
- A grade 3 tear is a complete rupture of the tendon or muscle. Generally if the person is active with work or sports the they will require a surgical repair. Older or nonactive patients may opt for conservative physiotherapy, although the healing time will be a lot longer and will most likely you will have ongoing deficits.
Predisposing factors for a rotator cuff tear:
- Primary or secondary shoulder impingement.
- Rotator cuff tendinopathies.
- A sudden increase in workload or training volume or intensity.
- Restricted shoulder movement.
- Injury to another area of the body such as the lower back causing compensatory movements.
- Stiffness of the neck or thoracic spine.
- Restricted shoulder movements, such as limited internal rotation.
- Tight muscles.
- Weak shoulder/shoulder blade stabilisers
- Poor core strength.
- Previous shoulder injuries.
- Poor manual handling.
- Faulty shoulder biomechanics.
Signs and symptoms of a rotator cuff tear:
- Generally there will be some pain or a twinge on aggravation.
- Pain and stiffness that is often worse the next day.
- Discomfort or pain on moving your arm.
- There may be less discomfort when someone else moves your arm for you (passive movement).
- Weakness of the arm.
Physiotherapy treatment of a rotator cuff tear may involve:
- Rest from aggravating activities.
- Ice to manage inflammation.
- Maintaining the movement in the shoulder while healing to prevent other conditions such as frozen shoulder from developing.
- Massage to break down scar tissue.
- Stretching to lengthen any restricted muscles.
- Strengthening the rotator cuff.
- Strengthening the scapular stabilisers.
- A full biomechanical assessment to ensure any predisposing factors such as impingement are corrected to preventing further injury.
- A progressive exercise program to ensure you are ready to return to work or sports without risk of reinjury.
- Manual handling education and training to ensure correct working habits: including lifting techniques, warm ups and stretching.
- Referral to a doctor or specialist if further interventions are required.