Rotator cuff injuries are common when it comes to treating the shoulder. Physiotherapist Luke from our Burnside practice explains the rotator cuff, how it can be injured, the types of injuries that occur and symptoms of them, as well as how rotator cuff injuries can be treated by a physio.
What is The Rotator Cuff?
The rotator cuff includes 4 muscles: subscapularis, supraspinatus, infraspinatus and teres minor. These muscles work together to help stabilise your shoulder as they cuff around the head (ball) of your upper arm bone (humerus) as it rests in your shoulder capsule (socket).
Muscles of the Rotator Cuff
How is it Injured?
A rotator cuff injury, or tear, is characterised by injury of one or more of the 4 rotator cuff muscles. Below are 5 examples of possible mechanisms that cause rotator cuff damage or tears:
1. Chronic injury (wear and tear) – stress to the rotator cuff associated with repetitive movements during sports such as cricket, baseball, swimming and tennis or jobs such as painting and construction work.
2. Acute injury – these often occur from falling from height with an outstretched arm trying to catch yourself or lifting heavy amounts of weight with lurching shoulder movements.
3. Degenerative injury – aged related changes to our shoulder such as reduced blood supply and healing capacity, repetitive stress to the shoulder with or without rotator cuff tears or bony spurs (pointy bone growth) can increase the risk of sustaining rotator cuff tears.
4. Tendinitis – irritation or inflammation of the tendons of either of the 4 muscles of the rotator cuff.
5. Bursitis – the most commonly injured bursa of your shoulder (sub acromial bursa) protects the muscle and tendon of your rotator cuff from rubbing on the surrounding bones. This helps reduce tendinitis or wear and tear of your rotator cuff. When this bursa is inflamed it is known as bursitis, which is often caused by repetitive shoulder movements or infection.
Types of Rotator Cuff Tears
There are 2 main types of rotator cuff tears: partial thickness and full thickness tears. These refer to the size of the tear of the rotator cuff muscle/s and are classified as Grade 1, 2, or 3 depending on the severity of the tear. A partial thickness rotator cuff tear is when the tendon/muscle is damaged but not completely ruptured (torn), whereas full thickness tears are when the tendon/muscle has torn completely and separates the tendon/muscle from the bone.
Rotator Cuff Tear
How is a Rotator Cuff Tear Diagnosed?
After a thorough discussion regarding your symptoms and history, a physiotherapist will examine your shoulder. If a rotator cuff tear is suspected then a variety of physical tests, movements and palpation of the affected area is undertaken to determine if this is the case. If indicated by your physiotherapist, an x-ray can be taken to identify other associated pathology such as osteoarthritis or bone spurs, and in other cases an MRI or ultrasound may be conducted if indicated to locate and show the extent of the tear – please note these are not always required.
How is it Treated?
Non-operative treatment: This is the case for approximately 4 in 5 people, non-operative treatment may include the following:
- Exercise! To increase strength, flexibility and function while reducing pain.
- Activity modifications
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain
- Taping to reduce pain, increase stability and function
Operative treatment: The much rarer option – your physiotherapy or other medical practitioner (eg. GP, doctor) may recommend surgery to repair the rotator cuff if your symptoms aren’t improving, chronic symptoms, significant weakness or loss of function of your shoulder. This may also be indicated if your work or sports you play increases the risk of recurrent tears. This procedure is usually done using an arthroscopy by re-attaching the tendon of either of the 4 muscles of the rotator cuff to the upper arm bone (humerus), although an orthopaedic surgeon will discuss the best option with you if this is required.
Often, the risk of infection, increased recovery time and potential anaesthetic complications is avoided with non-operative treatment. However, in some cases, non-surgical treatment for rotator cuff tears may increase the size of the tear or provide restrictions to your lifestyle. This will be something your treating physiotherapy will talk to you about if necessary or applicable.
What is important to remember is that like many other injuries, rotator cuff injury is individual and different for everyone. Due the nature of the tear, muscles affected, sport/work requirements, age and a variety of other factors means that everyone will recover differently. This is why it is important to book in with a physiotherapist as we will discuss your timeframe of recovery, treatment options specific to you and help you recover optimally. If this is you, we invite you to book an appointment online or call up a Core Physiotherapy and Pilates clinic near you.
This blog was written by Luke Mrowka (Physiotherapist), from our Burnside practice.
Yamamoto, A., Takagishi, K., Osawa, T., Yanagawa, T., Nakajima, D., Shitara, H. and Kobayashi, T., 2010. Prevalence and risk factors of a rotator cuff tear in the general population. Journal of shoulder and elbow surgery, 19(1), pp.116-120.
Lin, J.C., Weintraub, N. and Aragaki, D.R., 2008. Nonsurgical treatment for rotator cuff injury in the elderly. Journal of the American Medical Directors Association, 9(9), pp.626-632.
Mayo Clinic, 2020. Rotator cuff injury. [ONLINE] Available at: https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225. [Accessed 18 January 2022].