Rotator Cuff Tear

A rotator cuff tear, rotator cuff injury or strain is a tear to any of the four rotator cuff muscles in the shoulder. The rotator cuff muscles are important for stabilizing the shoulder joint.

Rotator cuff tears are pretty common as the shoulder joint is very mobile and a torn rotator cuff can often happen through over-stretching or rapid twisting of the joint. We explain rotator cuff injury symptoms, treatment and rehabilitation and how you can treat this common cause of shoulder pain.

Rotator cuff strain symptoms

Acute rotator cuff tear symptoms

Supraspinatus muscleAn acute rotator cuff injury tends to happen as a result of a sudden, powerful movement as in falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or more commonly following a powerful pitch or throw. Symptoms of a torn rotator cuff will usually consist of sudden shoulder pain with a tearing feeling in the shoulder, followed by severe pain through the arm.

The athlete will  be unable to move the shoulder due to pain or muscle spasm. Severe pain in the shoulder is likely for a few days due to bleeding and spasm within the muscle although this usually resolves quickly. Specific tenderness will be felt at the point the muscle or tendon is torn. With a severe tear, the athlete will not be able to abduct your arm (raise it out to the side) without assistance.

Chronic rotator cuff tear symptoms

InfraspinatusA chronic rotator cuff tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the bone and is often asociated with an impingement syndrome. Symptoms are usually seen on the dominant or stronger shoulder and more often effect athletes over 40 years of age.

Pain is worse at night, and can affect sleeping. Pain will 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.

A professional sports medical practitioner will undertake a full rotator cuff injury assessment in particular resisted shoulder rotation exercises which will reproduce symptoms of rotator cuff injury.

Rotator cuff strain explained

Teres minor rotator cuff muscleThe rotator cuff is a group of muscles which work together to provide the shoulder joint with dynamic stability, helping to control the joint during rotation.

The rotator cuff muscles are 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, kayaking – often put the rotator cuff muscles under a lot of stress.

SubscapularisProblems with the rotator cuff muscles can be classed into two categories. Tears of the rotator cuff tendons or muscles which is also known as a rotator cuff strain. Inflammation of the tendons called tendinopathy or rotator cuff tendonitis.

Seek medical attention if the pain persists for more than 2-3 days, you are unable to work due to the pain, are unable to reach up or to the side with the affected arm after 2-3 days or move the shoulder and arm at all.  Also, for any acute injury where you are unable to move the injured shoulder as well as the uninjured shoulder.

Acute rotator cuff tear treatment

What can the athlete do? 

Essential first aid for a torn rotator cuff muscle or tendonCold therapy shoulder wrap is application of ice or cold therapy to reduce swelling. The sooner you get cold onto the injury the sooner you will stop swelling, inflammation and pain. 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 if you still need to go to work school as it will immobilize the shoulder but can be removed at night.

See a sports injury professional or physiotherapist who can advise on a full rotator cuff rehab program including rotator cuff exercises.

What can a Sports Injury professional do?

Prescribe pain relief and anti inflammatory medication. You may require imaging studies (x-ray, MRI, CT Scan) to confirm diagnosis, rule out a fracture if the injury is severe and determine the extent of the damage.

If the injury is quite severe and you are young and active, you might require rotator cuff surgery 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.

Chronic rotator cuff injury treatment

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 and heat alone during the later stages of rehabilitation may be more beneficial.

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 tear recovery time

Recovery time for a rotator injury 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.