What is a Rotator Cuff Tear?
A Rotator Cuff Tear is a very common injury. The rotator cuff has dual roles in that it stabilizes the shoulder joint as well as allowing for multi-directional movements. The rotator cuff is a group of 4 tendons (attaching muscles to bone) and muscles. These tendons and muscles connect the upper arm (humerus) to the shoulder blade (scapula).
The four main tendons and muscles of the rotator cuff are:
- Infraspinatus-a triangular shaped muscle whose purpose is to rotate the humerus and stabilize the shoulder joint externally.
- Supraspinatus-is a small muscle whose purpose is the move the arm away from the side of the body, also known as abduction.
- Subscapularis-this is the largest and strongest muscle of the rotator cuff group. It is also triangular shaped and provides stability for the shoulder along with allowing the humerus to turn inward, what is also known as internal rotation.
- Teres minor-is a slim and narrow muscle that allows external rotation of the arm, but also it helps prevent the humerus bone from sliding upward when the arm is abducted (lifting away from the side of the body).
Each originates at the shoulder blade and attaches to the front of the humerus, forming a cuff around the arm bone.
The shoulder joint is complex, and because of its ability to move in multiple directions, it is susceptible to injury. Any one of the four muscle groups can tear from overuse or trauma. There are two categories of rotator cuff tears, full-thickness, and partial-thickness.
A full-thickness tear is categorized when the rotator cuff tendon and muscle tear extends from top to bottom. A partial-thickness tear is categorized when part of, or some portion of, the tendon or muscle is torn. In other words, it is not torn all the way through.
What causes rotator cuff tears?
A rotator cuff tear can develop over time which is known as chronic, or, a traumatic incident may have occurred which is then known as acute. A chronic rotator cuff tear occurs over time with overuse due to repetitive movements with the arms working above shoulder level or away from the body.
The shoulder is a complex and interdependent joint. Meaning, when one part of the shoulder is damaged, commonly surrounding structures and tissue are also likely damaged. For example, with a chronic rotator cuff condition, the shoulder is likely to have been previously diagnosed with tendinitis, bursitis, or impingement. Also, commonly with a rotator cuff tear, the biceps head is irritated, and the labrum (ring of cartilage at the shoulder joint) may have a tear.
An acute rotator cuff tear occurs due to trauma such as a fall or lifting a heavy object overhead. Often people will report they hearing a “popping” noise followed up with intense pain and weakness.
A rotator cuff tear can happen to anyone at any age. The most common rotator cuff tears occur in middle-aged and elderly; however, certain jobs including athletes are also at higher risk.
A few common high-risk jobs include:
- Construction labors
- Factory workers
- Piper fitters
A few common high-risk athletes include:
- Baseball players, especially pitchers
- Football players
Symptoms of Rotator Cuff Tear
The severity of the shoulder pain varies from person to person. Most often people will report intense shoulder pain along with extreme weakness and tenderness of the shoulder. Occasionally you may hear popping or crackling noises with shoulder movement. Typically, the pain originates at the top of the shoulder and may radiate down the side of the arm.
Along with pain and weakness, the shoulder will lose full range of motion. No matter how hard you try, you can barely lift your arm. Often people will report their arm feels heavy and they can no longer reach out in front or behind themselves.
How is a rotator cuff tear diagnosed?
Conservative diagnosis completed by a PT (physical therapist). With a thorough examination, a PT can often determine not only if you have a rotator cuff tear, but also which tendon and muscle have a tear.
Conducting a review of your medical history and performing special tests to determine which tendons and muscles are injured is all part of diagnosing a rotator cuff tear. Your PT will test each muscle of the shoulder including having you perform certain arm movements like lifting your arm away from your body, rotating your arm, and reaching behind your back.
They may perform some resistance during arm movements, but don’t be alarmed as they are checking for muscle strength. This testing can cause some discomfort, but don’t worry they are not doing any further damage to the shoulder. They are trained experts in the musculoskeletal system.
Also, your PT will ask specific questions related to your symptoms including:
- When was the onset of your symptoms?
- What activities make the pain worse?
- Where is your exact point of pain?
- Was there any trauma to the shoulder? If so, what was it?
- Was the onset of your symptoms gradual or immediate?
- Do you perform repetitive activities?
If you seek medical care from a physician, they too will go through a medical history and examine the shoulder. Quite often, they will order an image like an MRI (magnetic resonance imaging) to look internally at the shoulder structure. The MRI will look closer at the shoulder structure along with images of the tissue and will provide information about swelling and possibly damage to the tissue, like a tear.
Treatment of a Rotator Cuff Tear
The good news is not every rotator cuff tear needs surgery. After a thorough exam, a customized plan of care will be developed for you. Whether you have surgery or not, PT (physical therapy) is recommended as a follow-up to the injury. Proper training and treatment in movement, strengthening, and returning to activities is critical.
With a conservative, non-surgical approach, a PT will complete a full exam of the shoulder and establish a customized plan including goal setting. Your PT will also select appropriate treatment interventions to return you to functional activities safely.
Basic treatment will start with pain management, gentle range-of-motion exercises, and overtime when appropriate; your PT will advance to strengthening exercises. During this time, sometimes pain or anti-inflammatory meds may be needed. If this is the case, your PT will make the appropriate recommendation to you and your physician. A PT cannot prescribe drugs, but he or she can establish a plan with you and your physician.
If surgery were indicated, recovery time at a minimum would be four months. More likely than not, a full recovery may take up to one year. There are four phases to PT with rotator cuff recovery:
- Phase I (Protection)-the first few weeks after surgery you are at the highest risk of reinjury. Your arm will be in an immobilizer sling which will not only protect the shoulder, but it will also provide you some comfort. The main goal during this phase is pain management. Your PT will teach you how to properly sleep to avoid shoulder strain as well he or she will work on muscle tone balance around the shoulder. Trauma can sometimes cause muscles to overwork or even cause muscle spasms. Also, during this phase, you will begin with basic and gentle movements of the shoulder. Your PT will teach you how to protect the shoulder during daily activities. Starting activity too soon may jeopardize the full recovery of the shoulder.
- Phase II (Conservative Movements)-the goal is to start restoring movement. You will start to wean off the immobilizer and work will begin on increasing range of motion along with basic strengthening of the shoulder and surrounding areas is critical. You will gradually begin to use your arm for daily activities, but at this phase, no heavy lifting is recommended.
- Phase III (Restoring Activities)-the goal of this phase is to regain function of the arm. Your PT will advance your strengthening and will begin to phase in normal daily activities. Phase III is a critical time of recovery because too much activity too soon can harm the recovery of your shoulder. Return to full use of the arm is typical in this phase.
- Phase IV (Return to All Activities)-at this stage of recovery, full use of your arm is the goal. At this point returning to sports and work is safe. The key is increasing activity levels without reoccurrence of symptoms. Also in this phase, your PT will provide you with a shoulder maintenance program so you can avoid reoccurrence of injury.
Seek out medical attention if your shoulder pain is persistent, worsens, or is impacting daily activities such as work, hobbies, or sleep. Contact your local medical provider whether that be your physical therapist or your physician to establish a plan that is right for you.
As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
To find a highly qualified PT near you, please click on Find A Clinic. Here you will find highly qualified PTs. There are many PTs to choose from, but we can help you find a local PT that has top national outcome rankings for shoulder care.