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Rotator Cuff Tear

Rotator Cuff Tear

  • Posted by Michael Iudica
  • On July 22, 2023

A tear in my rotator cuff? What is it and is surgery my only option?

So, you have hurt your shoulder and found out that you have a tear in your rotator cuff. What does this actually mean?

The rotator cuff may have a simple name, but it serves a very important function. It is composed of 4 muscles that connect from your shoulder blade (scapula) to your upper arm bone (humerus), and is referred to as a dynamic stabiliser of the arm.[1] That is, it helps control the movement of your arm when using it, whether that be reaching down to pick something up from the floor, grabbing something from overhead, or when going to hug a loved one (cute).

Illustration showing rotator cuff tear

Illustration showing rotator cuff tear

But how is it injured?  Trauma may be the obvious, where you could have landed from a fall with your arm in a funny position, or tried to lift something a little too heavy. It can also be a consequence of overuse, with constant repetition and excessive repetitive loading being the culprit. The one out of our control is associated with natural age-related changes, where you get relative weakening of the muscles as you get older, making you more susceptible to injury.  Injury may be isolated to one or a combination of these factors.[2]

If you are thinking that surgery is your only option, you would be delighted to know that it isn’t. Management will depend on many factors, including but not limited to the size, location, and number of tears. The typical options include physiotherapy (including exercises), surgery, or injection therapy.

Physiotherapy (including exercise) vs Surgery

A tailored exercise program is fundamental for improving the strength and functional capacity of your arm to ensure it can keep up with the demands of your day-to-day activities. For small acute tears or degenerative/age-related tears, exercise has been shown to be clinically as effective in improving pain and function when compared to surgical groups.[3][4][5] Typically, a period of exercise therapy is trialled prior to surgery, however, it is important to discuss your injury with a health professional to develop an appropriate management plan.

Exercise vs Injection

Injection types can include corticosteroid or plasma rich protein, which have been shown to improve pain and function over a 3-6-month period.[6] In comparing physiotherapy advice (with exercise prescription and self-management strategies) with steroid injections + the same advice, there were no added benefits in getting the steroid injection. It did, however, improve exercise participation.[7] On a final note, a scan by itself should not be used for a diagnosis. Some rotator cuff tears can be completely asymptomatic and have no impact on pain or function, and may have been there for many years![8] It is important to correlate the findings of the scan with a clinical assessment for appropriate diagnosis and management.

Make an appointment to discuss your shoulder pain with one of our physiotherapists.

 

References:

  1. Akhtar, A., Richards, J., & Monga, P. (2021). The biomechanics of the rotator cuff in health and disease – A narrative review. Journal of clinical orthopaedics and trauma, 18, 150–156. https://doi.org/10.1016/j.jcot.2021.04.019
  2. Rotator cuff injury – statpearls – NCBI bookshelf. National Library of Medicine, National Center for Biotechnology Information. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK547664/
  3. Ranebo, M. C., Björnsson Hallgren, H. C., Holmgren, T., & Adolfsson, L. E. (2020). Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. Journal of shoulder and elbow surgery, 29(3), 459–470. https://doi.org/10.1016/j.jse.2019.10.013
  4. Khatri, C., Ahmed, I., Parsons, H., Smith, N. A., Lawrence, T. M., Modi, C. S., Drew, S. J., Bhabra, G., Parsons, N. R., Underwood, M., & Metcalfe, A. J. (2019). The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis. The American journal of sports medicine, 47(7), 1734–1743. https://doi.org/10.1177/0363546518780694
  5. Kukkonen, J., Joukainen, A., Lehtinen, J., Mattila, K. T., Tuominen, E. K., Kauko, T., & Äärimaa, V. (2015). Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up. The Journal of bone and joint surgery. American volume, 97(21), 1729–1737. https://doi.org/10.2106/JBJS.N.01051
  6. Jiang, X., Zhang, H., Wu, Q. et al.Comparison of three common shoulder injections for rotator cuff tears: a systematic review and network meta-analysis. J Orthop Surg Res 18, 272 (2023). https://doi.org/10.1186/s13018-023-03747-z
  7. Hopewell, S., Keene, D. J., Heine, P., Marian, I. R., Dritsaki, M., Cureton, L., Dutton, S. J., Dakin, H., Carr, A., Hamilton, W., Hansen, Z., Jaggi, A., Littlewood, C., Barker, K., Gray, A., & Lamb, S. E. (2021). Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT. Health technology assessment (Winchester, England), 25(48), 1–158. https://doi.org/10.3310/hta25480
  8. Lawrence, R. L., Moutzouros, V., & Bey, M. J. (2019). Asymptomatic Rotator Cuff Tears. JBJS reviews, 7(6), e9. https://doi.org/10.2106/JBJS.RVW.18.00149
Michael Iudica
About Michael Iudica

Michael Iudica has an interest in the assessment and management of the spine and sporting related injuries. Michael uses a combination of exercise therapy and manual techniques (like joint mobilisation or soft tissue massage) to help a patient reach their goals.