Rotator Cuff Tear

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

Because the shoulder joint has a large range of motion it is common that a rotator cuff muscle or tendon can tear through over stretching or rapid twisting of the joint. We explain the symptoms, treatment and rehabilitation to help cure your injury and prevent it recurring.

Symptoms

Symptoms of a torn rotator cuff will usually consist of sudden pain in the shoulder sometimes accompanied by a tearing feeling. This can be severe and may transmit down into the arm. The patient will often be unable to sleep on the injured shoulder and there may be signs of 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.

Rotator cuff strain explained

The rotator cuff is a group of muscles which work together to provide the shoulder joint with dynamic stability, helping to control the joint as it rotates. 

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.

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.

Treatment

What can the athlete do? 

Essential first aid for a torn rotator cuff muscle or tendonCold therapy shoulder wrap is applying ice or cold therapy to reduce pain and swelling. The sooner cold is applied 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.

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.

What can a Sports Injury professional do?

A doctor may prescribe pain relief and anti inflammatory medication. Imaging studies such as x-ray, MRI or CT Scan can confirm the diagnosis, and rule out a fracture.

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.

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 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.