What is the Rotator Cuff?
The rotator cuff is the name given to a group of 4 small muscles that are responsible for connecting the upper arm bone (humerus) to the shoulder blade (scapula) as well as adding stability and creating movement at the shoulder joint.
What Causes a Rotator Cuff Tear?
Injury to the rotator cuff muscles can happen due to trauma (like a fall or lifting a heavy object), repetitive activities using the arms above shoulder height (such as many overhead sports like volley ball), and the natural breakdown of tissue due to the aging process. These processes cause the muscles/tendons of the rotator cuff to become inflamed. Eventually if untreated, a tear to one of the muscles/tendons can occur. There are 2 types of tears that can occur to the muscles of the rotator cuff. A partial thickness tear is one that affects only some portion of any of the rotator cuff muscles/tendons, but does not completely extend all the way through the tissue. A full thickness tear is one that extends from the top to the bottom of any of the rotator cuff muscles/tendons.
What are some signs/symptoms?
Rotator cuff tears can present in a few different ways:
- Shoulder weakness – The injured arm may feel heavy/weak. Common ways that people may describe this symptom is: “I am having difficulty lifting my arm past my shoulder.” or “My arm feels weak when I try to lift it over my head.”
- “It hurts when I try to lift my arm up to put on a t-shirt” or “I feel a sharp increase in pain when I try to reach into my back pocket to take out my wallet” are things one might say when they are experiencing problems associated with a rotator cuff tear. You may be having pain on top of the shoulder/down the outside of the arm especially when moving the arm overhead or behind the back – A tear can produce pain that may even prevent you from performing daily activities that require you to raise your injured arm like putting on a pull-over t-shirt, or reaching your arm behind you to take out your wallet or tuck in your shirt. It is important to know that the size of the tear does not necessarily correlate with amount of pain. Small tears can induce a large amount of pain whereas larger more complete tears may not provoke much pain at all.
- Loss of motion at the shoulder – This can occur because of pain and weakness. You may find yourself saying or thinking “I don’t move my arm as much because I am afraid of causing pain.” Or “I haven’t been using my arm as much because it feels weak and hurts when I move it.”
When you first start to notice pain in your shoulder it is recommended that you rest and try to avoid the motions that cause you pain. Ice can be used to help decrease pain and inflammation around the shoulder joint. However, if you ever feel pain in the shoulder that lasts longer than 1-2 weeks, it is recommended that you make an appointment to see your physical therapist. It is important to know that the sooner you address the problem the better the outcome will be. With a comprehensive examination/evaluation and the use of special tests which are used to put stress on the muscles and tendons of the rotator cuff, a diagnosis can be made as to which muscle(s) are affected and are causing the onset of symptoms. In some cases, some special tests may warrant a referral to a specialist for image testing like an MRI or CT scan if a full thickness tear is suspected.
Once a diagnosis is made, the physical therapist will design a personalized program of modalities such as ice to control inflammation, as well as an exercise program to help strengthen the muscles of the rotator cuff. The exercise program will also help improve muscular endurance and flexibility to help increase the range of motion at the shoulder joint. Additional manual therapy techniques may be utilized such as joint mobilizations and superficial/deep tissue massage techniques to help decrease pain, remove trigger points, and increase the range of motion of the shoulder joint. In cases of severe tears, surgery may be needed to completely heal the damaged tissue. In this case physical therapy will be completed after the surgery to help improve strength and range of motion at the joint. If surgery is not completed, the physical therapist can help you modify activities to improve shoulder movement.
The healing process for a rotator cuff tear is not short by any means. Generally patients start to feel the effects of therapy after about 2 weeks. However, it takes a full 12 weeks of treatment 2-3 times per week in order to have any lasting effects. Re-injury is common in individuals who have had problems with their rotator cuff. It is important to continue to see a physical therapist routinely to continue to progress and strengthen the shoulder to prevent another injury from occurring.
1. Lansdown DA, Feeley BT. Evaluation and Treatment of Rotator Cuff Tears. The Physician and Sportsmedicine. 2012;40(2):73-86.