Your rotator cuff is made up of 4 muscles which assist with centralising your humeral head (the ball) in the socket part of your shoulder whilst producing movement.
Injury to these specific muscles around your shoulder joint can happen in 1 of 2 ways.
It can either happen suddenly after a specific traumatic event, such as a fall. Or it can happen gradually over time due to overuse.
- Repetitive stress – repeating the same shoulder movement again and again can overload the rotator cuff muscles and tendons.
- Lack of blood supply – as we get older, the blood supply within our rotator cuff muscles naturally reduces. The body’s ability to repair damage to this area is impaired due to this reduction in blood supply. This may result in a tear within the muscle or the tendon.
- Bone spurs (bone overgrowth) – these often form under the acromion and is more commonly seen as we age. When you lift your arm up over your head, this spur can rub on your rotator cuff tendons. This is called a shoulder impingement and can eventually lead to a chronic tear in the area.
What are the symptoms of a rotator cuff tear?
It is important to understand that everyone is different and every case is different with varying contributing factors. It is important to take this into account when your shoulder injury is being assessed. Not everyone presents in the same way, but below are some of the symptoms you may experience if you have a rotator cuff tear:
- Pain at rest and particularly at night.
- Pain while sleeping on the affected arm.
- Pain is usually in the front of your shoulder and can radiate down your arm.
- Pain with certain movements
- Weakness in your arm
- Weakness and/or pain while performing routine activities such as tucking your shirt in or even getting your shirt on or off.
Your physio may send you for further imaging assessments such as an ultrasound or an x-ray to assist in the diagnosis of a rotator cuff tear.
It is important to understand that if an extensive tear is not treated effectively, this can lead to an arthritic shoulder joint which ultimately will increase your pain and reduce your function over time.
How do you treat a rotator cuff tear?
The ultimate aim of treating a rotator cuff tear is to reduce pain and improve your shoulder function. Once again, many factors need to be considered as to which is the best approach for this shoulder injury. Factors such as your age, activity level, level of current function, general health, the amount of pain you have as well as the type and size of the tear all need to be taken into account.
The conservative option is generally the first point of call (this is not always the case if the rotator cuff tear is a traumatic tear in a young individual). If the rotator cuff is an injury that has happened gradually over time, conservative options are generally better. Conservative options include pain medications, anti-inflammatory medications, activity modification as well as physiotherapy to assist in regaining movement and muscle strength while still respecting the pain aspect of this condition.
Surgery is recommended if the conservative options have not improved the shoulder pain and function. Surgery is usually done arthroscopically (keyhole surgery). You can expect to be in a sling for 6 weeks followed by intense physiotherapy thereafter. It usually takes between 5-6 months to recover from rotator cuff surgery.