Rotator Cuff Tear
A rotator cuff strain is a tear to any of the four rotator cuff muscles in the shoulder and is common in throwing and racket sports.
Rotator cuff tears can range from mild to severe. Treatment consists of reducing pain and inflammation followed by a full rehabilitation program consisting of mobility, strengthening and sports specific exercises.
Torn rotator cuff symptoms will consist of sudden pain in the shoulder sometimes accompanied by a tearing feeling. Symptoms may radiate down into the arm. The patient will often be unable to sleep on the injured shoulder and there may be signs of shoulder impingement where the tendon pinches between the ball and socket of the shoulder joint when moving the arm out over head height.
Pain can gradually get worse over time and eventually weakness in the shoulder will occur to the point where the athlete is unable to lift their arm up to the side. Overhead movements such as in racket sports become very difficult.
Read more on rotator cuff tear symptoms including when to seek medical attention.
A rotator cuff tear is usually caused by over stretching or a rapid twisting of the joint. There are four rotator cuff muscles in the shoulder which work together to privide the joint with dynamic stability, helping to control it as it rotates. Because the shoulder joint has a large range of motion and often needs to move at very high speeds such as in throwing sports there is a higher risk of injury to the muscles or tendons (which join muscle to bone).
The rotator cuff muscles consist of the supraspinatus, infraspinatus, teres minor and subscapularis muscles. Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles particularly in sports which involve a lot of shoulder rotation, for example bowling in cricket, pitching in baseball, swimming and kayaking. The injury is also more common in the older athlete, particularly where long term overuse or degeneration is present.
In throwing events it is often the case that injury is caused by the rapid deceleration or stopping of the arm once the throw has been released rather than the acceleration phase of the throw.
Treatment for a rotator cuff tear consists of reducing the initial pain and inflammation, allowing the tissues to heel followed by a full rehabilitation program consisting of mobility, stretching, strengthening and functional shoulder exercises.
What can the athlete do?
Essential first aid for a torn rotator cuff muscle or tendon is rest and applying the PRICE principles of protection, rest, ice, compression and elevation. Apply ice or a cold therapy compression wrap to reduce pain and swelling. The sooner cold is applied the sooner you will stop swelling, inflammation and pain and the faster the healing process can begin. Cold therapy can be applied for 10 minutes every hour reducing to 3 or 4 times a days as pain reduces.
Rest the arm. A sling can sometimes be useful for more severe rotator cuff injuries if you still need to go to work school as it will immobilize the shoulder but can be removed at night. Once the acute stage is over mobility and strengthening exercises can begin as long as they are done pain free.
If the injury is more than a few days old and it has become chronic then alternating heat and ice may also be more beneficial and heat alone during the later stages of rehabilitation is often advised.
Read more on rotator cuff tear rehabilitation.
What can a Sports Injury professional do?
Sometimes you might be referred for a steroid injection directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation. A full rehabilitation program consisting of stretching and strengthening exercises will be advised.
Shoulder massage including cross friction massage to the rotator cuff tendon can break the injury down to its acute stage to allow correct healing of the injury to take place.
Rotator cuff surgery?
If the injury is quite severe and you are young and active then surgery may be indicated to repair the tear. People who are more likely to need surgery include:
- Athletes under 60 years old.
- Patients with complete tears of the rotator cuff tendon or muscle.
- If conservative treatment of rest, ice, exercises and other treatments is not having the desired effect after 6 weeks
- Professional sports people who want the short cut to making sure the injury heals in the shortest possible time.
- If your job requires constant shoulder use then surgery for a severe injury may be preferable.
Recovery time for a torn rotator cuff will vary depending on several factors. Conservative treatment has a 40-90% success rate at fixing the problem. Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function. Very extensive tears often have a poor surgical outcome, however this injury is thankfully quite rare. If you are older, it will take you longer to heal.