08 Apr Rotator Cuff Tears – Causes, Symptoms, and Treatment

What is a Rotator Cuff Tear?

One of the most common complaints from the middle-aged, is shoulder pain. A frequent source of that pain is a torn rotator cuff.

The rotator cuff is a group of muscles and tendons that lay over the head of the humerus in the shoulder joint. Essentially the cuff holds the humerus in the shoulder socket, allowing the shoulder to lift the arm, rotate it, and reach up over the head.

Rotator cuff tears come in all shapes and sizes. Most common are tears occurring in the ten-don. A partial tear means the tendon did not completely sever the soft tissue. Full thickness tears or a “complete” tear, meaning that there was a split of the soft tissue into two, some-times detaching the tendon from the bone. It can start as a minor tear, but with overuse, it can quickly develop into a full tear causing major motion restriction and significant pain.

What Are Symptoms of a Rotator Cuff Tear?

 
The most common symptoms of a rotator cuff tear include:

• Pain at rest and at night, particularly if lying on the affected shoulder
• Pain when lifting and lowering the arm or with certain arm movements
• Weakness when lifting or rotating the arm
• Crepitus or crackling sensation when moving shoulder in certain positions

 
With these symptoms in mind, it is easy to understand how simple daily activities, such as combing your hair, getting dressed, or buckling your seatbelt may become painful and difficult to perform when suffering from a rotator cuff tear.

What Causes a Rotator Cuff Tear?

There are two main causes of rotator cuff tears: injury and wear.

• Injury to the rotator cuff can occur when falling down on an outstretched arm or by lifting something too heavy with a jerking motion. Even an elbow dislocation or a wrist fracture from a fall can cause damage to the rotator cuff.
• Wear. Most rotator cuff tears are the result of a wearing down of the tendon(s), which occurs slowly over time. Rotator cuff tears from wearing occurs most often in people who repeatedly perform overhead motions in their jobs or while participating in sports.

 
The risk of a rotator cuff injury also increases with age. It can be worsened by excessive activity— repeating the same shoulder motions again and again, so it makes sense for rotator cuff tears to be seen most common among people over 40 who often participate in activities that have repetitive overhead motions.

Baseball, tennis, and weightlifting are some examples of sports that have repetitive overhead motions. Many jobs and routine chores can cause overuse tears as well. Examples include painters and carpenters.

How Are Rotator Cuff Tears Diagnosed?

Your doctor will base a diagnosis of a rotator cuff tear on your symptoms and a physical examination. During the examination, your doctor will move the arm in several different directions, measuring the shoulder’s range of motion. Then your doctor will observe the active motion of your arm noting specific and important information about the motions that cause you pain. Because pain is very subjective, and every person’s tolerance level differs, an individual may not even realize there is a small rotator cuff tear, which is why your doctor may order addition-al tests which may help confirm the diagnosis such as an X-ray and/or an MRI.

How Are Rotator Cuff Tears Treated?

The primary goal of treatment for a rotator cuff tear is to minimize pain and improve function. Your doctor will plan a course of treatment that considers your age, activity level, general health and type of tear. Research has shown that over 50% of patients find relief from their symptoms without surgery.

Doctors may initially choose a conservative treatment plan based on nonsurgical options, which often include rest, non-steroidal anti-inflammatory medication (aspirin and ibuprofen) to reduce pain and swelling, as well as a cortisone steroid injection. Cortisone is a very effective an-ti-inflammatory medicine. Doctors use injections cautiously because in some cases they may weaken the soft tissue.

What Does Therapy Do for a Torn Rotator Cuff?

“One of the most common questions I receive from new rotator cuff tear patients is, “since occupational therapists don’t perform surgery, how is therapy helpful,” offered Kathy Baker, occupational therapist at Trio Rehab. “They’re often surprised when I explain that therapy has been
proven to eliminate the need for surgery 75 percent of the time in patients with a
traumatic full thickness rotator cuff tear,” Baker added.

Prior to therapy, your occupational therapists should perform a thorough assessment of the rotator cuff and provide specific shoulder exercises that address the key impairments noted. Typically a therapy program will initially focus on stretches to improve flexibility and range of motion, and then progress to strengthening the unaffected muscles that support your shoulder to relieve pain and prevent further injury.

When is Therapy Needed to Treat Rotator Cuff Tears?

Surgery may be recommended after therapy if symptoms do not improve. Surgery is a suitable option when the individual is active and require arms for overhead work or sports. Surgery may also be the best option for reasons such as chronic symptoms of pain and/or weakness that have persisted for more than six months, or with larger tears that are more than three centi-meters.

Following surgery, a therapy program may be initiated to start passive motion and slowly progress to active motion. Once active motion is achieved, a full strengthening program is utilized to help return the individual to performing prior activities.

When it comes to therapy, the bottom line is that it plays a vital role in getting individuals back to their daily activities after a rotator cuff tear, regardless of whether treatment is surgically or non-surgically. A therapy program will help to regain shoulder motion and strengthen muscles while reducing pain even when the recovery process is slow. With a strong commitment to therapy, most patients can look forward to enjoying all those daily activities again.

About the Author:
Kathy Baker, OT, CHT
Kathy graduated from the University at Buffalo in 1992 with a Master’s Degree in Occupational Therapy. She continued her education at Texas Woman’s University where she became a Certified Hand Therapist.