Could You Have A
Torn Rotator Cuff?

A torn rotator cuff does not always mean surgery. What is the rotator cuff? How do you know if a tear is causing your shoulder joint pain? If it is torn, how can you possibly avoid surgery?




What is a Torn Rotator Cuff?

The rotator cuff is a group of four muscles and tendons responsible for helping to stabilize and move the shoulder joint. The four muscles of the rotator cuff include the supraspinatus, subscapularis, teres minor, and infraspinatus.



The tendon portion of the rotator cuff is simply the portion that attaches the muscle to the bone (in the picture, the red portion is the muscle and the white the tendon). The rotator cuff muscles are small stabilizer muscles and provide the majority of the stability for the shoulder joint. Of the four cuff muscles, the most common tendon injured is the supraspinatus.

Rotator cuff tears can be partial or full thickness. Although a tear in the rotator cuff itself does not heal (meaning the ends of the tear do not reconnect), a return to normal function is possible, even without surgery.



Cause of Rotator Cuff Tears

Injury to the rotator cuff can occur with or without trauma. Most often the rotator cuff becomes injured over time from repetitive stress. Repetitive overhead movement, such as throwing, swimming, or lifting, can cause rotator cuff tears. The most common trauma affecting the rotator cuff is a fall on the outstretched arm. The risk of rotator cuff tears increases when bone spurs form, compressing the rotator cuff and creating micro tears over time.


Typical Symptoms of Rotator Cuff Tears


The most common symptom of a torn rotator cuff is pain over the lateral or outside aspect of the shoulder. Occasionally, pain can radiate down the side of the arm toward the elbow (symptoms from the rotator cuff will NOT go past the elbow).

Functionally, the most common complaint is pain and limitation with moving the arm up and out to the side. If you are unable to lift your arm, this could indicate a more significant rotator cuff tear. Most rotator cuff tears do not require surgery. However, full thickness tears that lead to a significant limitation in the ability to raise the arm often indicate surgical intervention may be necessary.


shoulder abduction rotator cuff tear

Daily activities that are often effected include sleeping on the involved side, reaching and lifting items such as a gallon of milk out of the refrigerator or an item into an overhead cabinet, and pain with washing or fixing hair.


Typical Conservative Treatment Protocol

As with all joint issues, treatment goals include first reducing inflammation, second restoring range of motion (ROM), and third restoring strength.

When significant pain is present often significant inflammation is also present. Utilizing ice therapy to minimize inflammation is greatly helpful. Ice should be place directly over the lateral aspect of the shoulder for 10 to 15 minutes. In addition, anti-inflammatory medication can be warranted (consult your doctor regarding medications). If micro tears have created a chronic inflammatory condition within the shoulder, cortisone injections may be recommended to help minimize the inflammation.

Despite the fact the ends of the rotator cuff tear do not reconnect, normal strength and function can be obtained.



Physical Therapy Exercise

If the shoulder is not limited in range of motion, no stretching exercises are necessary. If there is a limitation in ROM, it is important that range of motion be restored before initiating strengthening exercises.

When one of the cuff tendons tears, strengthening exercises are utilized to strengthen the other supporting muscles of the shoulder. It is important that when performing these strengthening exercises that they be pain free.

In addition, because the rotator cuff muscles are stabilizer muscles, muscle endurance is the goal. Thus, the emphasis for strengthening exercises should be on utilizing minimal weight and a higher number of repetitions. When the exercises become easy, increase the number of repetitions before increasing the weight of the exercise.

The following is a link to a physical therapy exercise program for assisting the restoration of ROM and strength following a torn rotator cuff: Torn Rotator Cuff Exercises.


Surgery

Repairing a rotator cuff tear is a significant surgery. Following rotator cuff surgery, the shoulder will be immobilized for up to six weeks. Rehabilitation following a rotator cuff repair is an involved process lasting as long as four months.

Following the repair, active movement is not allowed for approximately six weeks. Controlling pain and swelling in the initial post surgical period is of primary importance. The use of ice and pain medication should be utilized as needed.

During the first six weeks post surgery, passive stretching exercises and stretching by a physical therapist is required. A potential complication following surgery at this stage is the development of frozen shoulder. Obviously because of the limitation of active motion, daily functional activities can be a challenge. This is especially true if surgery is on your dominant side. Sleeping can also be quite a challenge with many resorting to sleeping in a recliner to avoid shoulder pressure.

After the initial six week period active motion is allowed. Depending upon how quickly active motion is restored will determine how early strengthening exercises will be initiated. Strengthening exercises will include strengthening muscles around the scapula in addition to rotator cuff muscles.

Because of the length of recovery necessary following rotator cuff repair, surgery should be the option of last resort. Surgery should only be considered if you continue to have significant pain, limitation in the use of your arm, and medication, injections, and physical therapy has failed.


Summary

• The rotator cuff is a group of four tendons that function to help provide dynamic stability for the shoulder.

• The most commonly injured tendon is called the supraspinatus.

• Pain in the lateral shoulder and limitation with moving the arm up and out to the side are the most common signs and symptoms associated with a cuff tear.

• Depending on the size of the cuff tear, surgery may not be necessary.

• Typical conservative treatment a torn rotator cuff includes ice therapy, anti-inflammatory medication, cortisone injections, and physical therapy.

• Surgery for rotator cuff repair is a lengthy process and should only be considered after conservative treatment has failed and you continue to experience significant pain and functional limitation.

• To improve the mobility and strength of the shoulder following a cuff tear, follow this program: Torn Rotator Cuff Exercises.

A torn rotator cuff is not always a surgical situation. Follow the recommendations to assist you in reducing your pain and restoring your shoulder mobility.




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