So you’ve got a rotator cuff tear – what should you do?
Thomas Mallett is a physiotherapist from Formation Physio in South Hurstville. Today he talks to us about rotator cuff tears and what you can do about it
What is the rotator cuff?
The rotator cuff consists of four deep muscles in your shoulder which work together to keep the shoulder stable while you move it. In other words, they are the muscles that work really hard to stop your shoulder from dislocating.
The diagram below shows the four muscles of the rotator cuff;
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
The muscles of the rotator cuff sit underneath the bigger muscles of your shoulder which are responsible for moving your arm around.
How does the rotator cuff get injured?
There are many ways the rotator cuff can be injured. Common scenarios include:
A sudden (acute) tear can be caused by one major incident such as falling onto your arm or lifting an object awkwardly
Tears can also occur gradually over time from repetitive overhead tasks such as throwing or swimming.
It is also common for degenerative tears to develop in older people – which is a perfectly normal part of the ageing process (just like how your hair turns grey!).
Interestingly, some of these degenerative tears won’t ever cause pain or physical limitations, but some can become painful.
Research has shown that 20-30% of people aged over 50 with NO SYMPTOMS have a rotator cuff tear… And this number increases with age!
What is the best management for rotator cuff tears?
Many different factors come into play when deciding the best management option.
For most tears which occur gradually or tears in older people, a period of strengthening should be trialled as the first treatment option.
This aims to strengthen the other muscles in your shoulder and increase your overall function.
If you are not happy with how your shoulder is progressing after 6-8 weeks then surgical review can be considered.
For acute tears, some will need a surgical review straight away, while others can be trialled with a period of strengthening.
Some of the factors influencing the decision for surgical review straight away include;
your age
what you need your shoulder for (sport, work)
size and type of the tear
how severe your pain and physical limitations are
how much your symptoms have settled initially
The debate about surgical vs non-surgical treatment for rotator cuff tears is a hot topic among researchers, with no clear evidence supporting one over the other... So make sure you stay tuned for updates as future evidence becomes available!
What does non-surgical treatment involve?
Non-surgical treatment involves a progressive exercise program which aims to restore your full range of shoulder movement and gradually progress your shoulder strength.
As your strength and movement progress back to normal (or better than before!) you will be gradually re-introduced to all your previous tasks.
This process usually takes between 6-12 weeks but is very dependent on how you are presenting and responding to the program.
What does surgical treatment involve?
Surgery involves re-attaching the torn part of the rotator cuff tendon to the bone in your shoulder (humerus). This is done by threading small tightropes through the tendon and attaching it to screws which have been placed into your humerus.
This is followed by 4-6 months of rehabilitation aiming to gradually progress you back to your previous activities.
For most protocols, the first 3-6 weeks involves wearing a sling and only gentle stretches for your shoulder. This is followed by a progressive strengthening program with common timeframes including:
Reaching below shoulder height 4-6 weeks, above shoulder height 6-12 weeks
Return to light work duties at 5-6 weeks
Return to driving at 6-8 weeks
Return to jogging 6-12 weeks
Return to heavy work duties or sports including swimming at 12-24 weeks
Return to contact sports at 24 weeks
However, these timeframes are just a guide and will differ from person to person. Returning to tasks is criteria-based, which means certain levels of movement, strength and comfort must be reached before returning to activities, rather than waiting a certain amount of time.
In summary:
The best treatment option varies greatly depending on you, the needs of your shoulder and the tear you present with. Having surgery is a big deal, so all other options should be considered (and in some cases trialled) before a surgical review is considered. As Physio’s we can help educate you about the different treatment options and guide you through the decision making process.
