Rotator Cuff Tears
Introduction
Physiotherapy in Calgary for Shoulder
Welcome to Momentum Health's patient resource about Rotator Cuff Tears.
The shoulder is an elegant and complex piece of machinery. Its design allows us to reach and use our hands in many different positions. However, while the shoulder joint has great range of motion, it is not very stable. This makes the shoulder vulnerable to problems if any of its parts aren't in good working order.
The rotator cuff tendons are key to the healthy functioning of the shoulder. They are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons is an especially painful injury. A torn rotator cuff creates a very weak shoulder. Most of the time patients with torn rotator cuffs are in late middle age. But rotator cuffs tears can happen at any age.
This guide will help you understand:
- what the rotator cuff is
- how it can become torn
- what treatments are available for a torn rotator cuff
Anatomy
What is the rotator cuff, and what does it do?
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).
Shoulder Bones
The rotator cuff connects the humerus to the scapula. The rotator cuff is formed by the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis.
Rotator Cuff
Tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The rotator cuff helps raise and rotate the arm.
As the arm is raised, the rotator cuff also keeps the humerus tightly in the socket of the scapula. The upper part of the scapula that makes up the roof of the shoulder is called the acromion.
Socket of the Scapula
A bursa is located between the acromion and the rotator cuff tendons. A bursa is a lubricated sac of tissue that cuts down on the friction between two moving parts. Bursae are located all over the body where tissues must rub against each other. In this case, the bursa protects the acromion and the rotator cuff from grinding against each other.
Related Document: Momentum Health's Guide to Shoulder Anatomy
Causes
What causes the rotator cuff to tear?
The rotator cuff tendons have areas of very low blood supply. The more blood supply a tissue has, the better and faster it can repair and maintain itself. The areas of poor blood supply in the rotator cuff make these tendons especially vulnerable to degeneration from aging.
The degeneration of aging helps explain why the rotator cuff tear is such a common injury later in life. Rotator cuff tears usually occur in areas of the tendon that had low blood supply to begin with and then were further weakened by degeneration.
This problem of degeneration may be accelerated by repeating the same types of shoulder motions. This can happen with overhand athletes, such as baseball pitchers. But even doing routine chores like cleaning windows, washing and waxing cars, or painting can cause the rotator cuff to fatigue from overuse.
Excessive force can tear weak rotator cuff tendons. This force can come from trying to catch a heavy falling object or lifting an extremely heavy object with the arm extended. The force can also be from a fall directly onto the shoulder. Sometimes injuries that tear the rotator cuff are painful, but sometimes they aren't. Researchers estimate that up to 40 percent of people may have a mild rotator cuff tear without even knowing it.
The typical patient with a rotator cuff tear is in late middle age and has had problems with the shoulder for some time. This patient then lifts a load or suffers an injury that tears the tendon. After the injury, the patient is unable to raise the arm. However, these injuries also occur in young people. Overuse or injury at any age can cause rotator cuff tears.
Symptoms
What does a rotator cuff tear feel like?
Rotator cuff tears cause pain and weakness in the affected shoulder. In some cases, a rotator cuff may tear only partially. The shoulder may be painful, but you can still move the arm in a normal range of motion. In general, the larger the tear, the more weakness it causes.
Rotator Cuff Tears
In other cases, the rotator cuff tendons completely rupture. A complete tear makes it impossible to move the arm in a normal range of motion. It is usually impossible to raise the arm away from your side by yourself.
Most rotator cuff tears cause a vague pain in the shoulder area. They may also cause a catching sensation when you move your arm. Most people say they can't sleep on the affected side due to the pain.
Diagnosis
When you visit Momentum Health, our physiotherapist will ask questions about your medical history, your injury, and your pain. We will then do a physical examination of the shoulder. The physical exam is most helpful in diagnosing a rotator cuff tear. A complete tear is usually very obvious. If our physiotherapist can move the arm in a normal range of motion, but you can't move the arm yourself, you most likely have a torn rotator cuff.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Momentum Health provides physiotherapist services in Calgary.
Our Treatment
Non-surgical Rehabilitation
When you begin rehabilitation at Momentum Health, our first goal will be to help control your pain and inflammation. Initial treatment is usually rest and anti-inflammatory medication, such as aspirin or ibuprofen. This medicine is used mainly to control pain. Treatments such as heat and ice are also used to ease pain and inflammation.
Our physiotherapist will then create an individualized program to help you regain shoulder function. We will use hands-on treatments and various types of exercises to improve the range of motion in your shoulder and nearby joints and muscles.
Later, we’ll begin strengthening exercises to improve the strength and control of your rotator cuff and shoulder blade muscles. Our physiotherapist will help you retrain these muscles to keep the ball of the humerus in the socket. This will help your shoulder move smoothly during all of your activities.
Our physiotherapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes to avoid further problems.
Although the time required for recovery varies, as a guideline you may need physiotherapy treatments for six to eight weeks. Most patients are able to get back to their activities with full use of their arm within this amount of time.
Post-surgical Rehabilitation
Rehabilitation after rotator cuff surgery can be a slow process. You will probably need to attend physiotherapy sessions for two to three months, and you should expect full recovery to take up to six months. Getting the shoulder moving as soon as possible is important. However, this must be balanced with the need to protect the healing tissues.
You will most likely have to wear a sling to support and protect the shoulder for several weeks (generally four to six weeks) after surgery. Your physiotherapist may use ice and electrical stimulation treatments during your first few physiotherapy sessions to help control pain and swelling from the surgery. Our physiotherapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain.
Physiotherapy can progress quickly after arthroscopic procedures. Our treatments start out with range-of-motion exercises and gradually work into active stretching and strengthening. You just need to be careful about doing too much, too quickly.
Physiotherapy goes slower after surgeries where the front shoulder muscles have been cut. Our physiotherapist will start you on exercises with passive movements. During passive exercises, we move your shoulder joint, while your muscles stay relaxed. Our physiotherapist gently moves your joint and gradually stretches your arm. We may teach you how to do passive exercises at home as well.
Active physiotherapy usually starts six weeks after surgery. You use your own muscle power in active range-of-motion exercises. We may have you begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues. We will probably delay normal strengthening exercises until 12 weeks.
Exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade. Our physiotherapist will help you retrain these muscles to keep the ball of the humerus firmly in the socket. This helps your shoulder move smoothly during all your activities.
Some of the exercises you'll do are designed to get your shoulder working in ways that are similar to your work tasks and sport activities. Our physiotherapist will help you find ways to do your tasks that don't put too much stress on your shoulder. Before your physiotherapy sessions end, we will teach you a number of ways to avoid future problems.
If all of these efforts to improve your shoulder condition fail, our physiotherapist may refer your for surgical evaluation. There are a few other surgical options such as tendon grafts and muscle transfers, which may help you regain use of your shoulder. However, these procedures are very complex and are rarely necessary.
Momentum Health provides services for physiotherapy in Calgary.
Physician Review
X-rays won't show tears in the rotator cuff. However, your doctor may want you to have a shoulder X-ray to see if there are bone spurs, a loss of joint space in the shoulder, or a down-sloping (hooked) acromion. These findings are associated with tears in the rotator cuff. An X-ray can also show if there are calcium deposits in the tendon that are causing your symptoms, a condition called calcific tendonitis.
Related Document: Momentum Health's Guide to Calcific Tendonitis
Your doctor will probably also want to do an arthrogram test. An arthrogram involves injecting dye into the shoulder joint and taking several X-rays. If the dye leaks out of the shoulder joint, there is probably a tear in the rotator cuff.
Your doctor may ask you to have a magnetic resonance imaging (MRI) scan.
An MRI scan is a special imaging test that uses magnetic waves to create pictures of the shoulder in slices. The MRI scan shows tendons as well as bones. This test is painless and requires no needles or injections.
