Rotator cuff tear - what should I do with it?
Muscles of the Rotator Cuff
What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. The shoulder joint is a ball and socket joint which allows large degrees of movements. The rotator cuff serves an important role in improving the stability of the shoulder and also coordinates with other muscles around the shoulder to move the arm.
How does a rotator cuff tear happen?
A rotator cuff tear means a loss of integrity or tearing of one or more of the rotator cuff muscle tendons. Rotator cuff tears can happen in two ways:
Rotator Cuff Tear
- Acute: it happens quickly when a person lift a heavy object or over-stretches the shoulder
- Chronic: it happens slowly as a result of wear and tear in the muscle’s tendon and can happen at any age, however it is the most common in late middle age.
What are the symptoms of a rotator cuff tear?
An acute tear is often felt during the incident when the person can immediately experience pain and loss of strength. A chronic tear can happen without pain as it is a part of normal ageing process. However, you can still experience one or more of the following symptoms:
- Inability to lift heavy objects
- Difficulty lifting arm above shoulder height
- Difficulty sleeping on the affected shoulder
What can physiotherapy offer?
Physiotherapy aims to provide a comprehensive assessment to identify the underlying cause of problem. Frequently, symptoms present with a rotator cuff tear are the result of overloading of the muscles and tendons from a sudden increase of activity level. In the majority of other cases, symptoms are due to underlying contributing factors such as incorrect lifting techniques, poor posture, muscle imbalance or weakness and / or a lack of shoulder and spinal flexibility.
To assist your recovery, a physiotherapist provides guidance for activity modification and will help you to gradually return to previous activity levels. Other treatments that are used by physiotherapy to help you to manage your condition include:
- Pain relief treatment (massage, manual therapy)
- Postural education and taping
- Exercise (muscle retraining, strengthening)
- Soft tissue release
Will I need surgery?
Rotator cuff tears often do not require surgery. A trial of 6 weeks of physiotherapy is generally recommended prior to deciding whether a person needs surgery. This is because physiotherapy has lower risk of infection and less complications. Research has also shown that physiotherapy treatment can provide similar long term outcome and satisfaction from surgery, but with a lower cost!
Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH & Smith HJ. Tendon Repair Compared with Physiotherapy in the Treatment of Rotator Cuff Tears A Randomized Controlled Study in 103 Cases with a Five-Year Follow-up. The journal of bone and joint surgery. 2014. 96(18): 1504-1514
Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J & Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabli Rehabli. 2017. 39(14): 1357-1363