Rotator Cuff Tear

Rotator Cuff Tear symptoms

Rotator Cuff Tear (Acute)

This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.

The symptoms of a Torn Rotator Cuff will usually include:

• Sudden rotator cuff pain with a tearing feeling in the shoulder, followed by severe pain through the arm.
• Limited movement of the shoulder due to pain or muscle spasm.
• Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly.
• Specific tenderness (“x marks the spot”) over the point of rupture/tear.
• If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance  

Rotator Cuff Tear (Chronic)

A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome.

• Usually found on the dominant side.
• More often an affliction of the 40 age group.
• Pain is worse at night, and can affect sleeping.
• Gradual worsening of pain, eventually some weakness.
• Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head.
• Some limitations of other movements depending on the tendon affected

What is a Rotator Cuff strain?

The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name).

The rotator cuff muscles include:

• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.

Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of the tendons (often called tendinopathy or tendonitis).

Seek medical attention if:

• The pain persists for more than 2-3 days.
• You are unable to work due to the pain/limitations.
• You are unable to reach up or to the side with the affected arm after 2-3 days.
• You are unable to move the shoulder and arm at all.
• For any acute injury where you are unable to move the injured shoulder as well as the uninjured shoulder.

What should I expect when I visit a professional?

• A detailed history of your general health, past problems and injuries, and what happened to cause this injury will be taken.
• Both shoulders will be looked at and compared (you will need to partially undress for this) both visually and using palpation (feeling).
• Your neck, elbows and wrists will be checked to make sure they are not contributing to the problem.
• Range of movement will be assessed, you’ll be asked to do certain movements and the clinician will observe and ask you to report any pain (but will not be done if a fracture is suspected).
• Passive range of movement will be assessed – you will be asked to lie on a couch while the clinician moves your shoulder (but will not be done if a fracture is suspected).
• Sensation and strength in the arm will be assessed.
• Some specific tests will be done which can help to identify which tendon is causing the problem and confirm if it is a rotator cuff tear, or due to inflammation or some other cause.

Rotator cuff injury treatment

Acute Tears

What can the athlete do? 

• An important part for a torn rotator cuff treatment programme is initial application of ice or cold therapy to reduce swelling
• Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
• Consider consulting a physiotherapist who can assist you with rotator cuff exercises and rehabilitating the injury

What can a Sports Injury professional do?

• Control the pain with appropriate medications
• You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures

Rotator cuff surgery

If the injury is quite severe and you are young and active, you might require a rotator cuff repair operation to fix the tear. Indications include:

• Under 60 years old
• Complete tears of the tendon/muscle
• Failure of other treatments after 6 weeks
• Professional/keen sports people
• If your job requires constant shoulder use

Chronic rotator cuff injuries

What can the athlete do?

• Control rotator cuff pain by applying ice or cold therapy.
• Alternating heat and ice may also be beneficial after the first 5 days have passed.

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
• Shoulder exercises which can be provided by a physiotherapist
• You may require surgery, with the indications as above

Rotator cuff tear healing time

• Recovery time for a rotator injury will vary depending on several factors. Conservative rotator cuff injury 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 due to changes in your physiology.

More Information:

• Rotator cuff assesment & diagnosis
• Rotator cuff rehabilitation
• Mobility exercises for the rotator cuff
• Strengthening exercises for the rotator cuff.
• Functional shoulder exercises
• Sports massage techniques for rotator cuff injuries
• Expert Interview - Chiropractor on rotator cuff injuries.