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Rotator Cuff Tear Treatment

Updated: May 5, 2022

Rotator Cuff Anatomy


Rotator cuff tears are among the most common shoulder injuries that people suffer. Each year, 2 million people see a physician for a rotator cuff injury in the United States according to the American Academy of Orthopaedic Surgeons. It is important to understand exactly what comprises the rotator cuff and how it becomes torn.


rotator cuff tear treatment
Jmarchn, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

The above image shows the back of the shoulder including three out of four rotator cuff muscles. Overall, the rotator cuff secures the head of the humerus in the shoulder joint and helps maintain the joint stability with movement. The four rotator cuff muscles come together to aid the labrum of the shoulder in securing the humerus. The shoulder is the most mobile joint in the body and it relies on muscular support more than any other joint. The rotator cuff muscles are the most important muscles in terms of shoulder joint support.


As I mentioned, the main purpose of the rotator cuff muscles is to support the shoulder, but they all have other functions as well. The supraspinatus primarily helps elevate the arm as you go overhead. The infraspinatus and teres minor help with external rotation, while the subscapularis creates internal rotation.


rotator cuff tear treatment
Injurymap, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

The most common muscle to be injured is the supraspinatus based on its use with any sort of shoulder elevation. It is also in a difficult position due to the anatomy around it compressing the tendon. This is especially worsened as we age, when we lose blood flow and gain bone spurs in the shoulder joint.


The nature of the tear is also an important component of understanding injury. Partial tears involve damage to the muscle or tendon that does not go all the way through the structure. Full thickness tears pierce the entire tendon. Obviously a full thickness tear typically results in worse symptoms, but that is not always the case. Oftentimes, rotator cuff tears are asymptomatic, particularly in older adults or those who repeatedly work overhead such as baseball players or manual laborers.


Rotator Cuff Tear Symptoms


Rotator cuff tears typically occur traumatically from a fall or from chronic wear and tear. Most commonly, if you slip and fall on an outstretched hand, the force can create too much stress for the rotator cuff to handle. Chronic stress from overhead athletics or labor can lead to a rotator cuff tear overtime. In these cases there is often not a single inciting incident, but you may notice a gradual onset of symptoms.


rotator cuff tear treatment
https://pxhere.com/en/photo/80370

The primary symptom of a rotator cuff tear is pain with overhead movements. Pain is a primary motivator to seek treatment, as you can often compensate for mobility or strength limitations. Initially, pain may only occur with overhead movements or heavy lifting. As symptoms worsen, pain may be felt with less movement and less load. Eventually pain can be felt at rest. A common irritating position is lying on the affected shoulder, especially when sleeping.


Weakness is also a common symptom due to the damage to the muscle. The exact weakness depends on the injured muscle, but the rotator cuff is responsible for shoulder stability. Any rotator cuff tear has potential to decrease overhead strength due to the increased stress on the shoulder.


Mobility can be limited due to poor stabilization of the shoulder. If there is pain or weakness of the shoulder, then you are less likely to use it in its full range. Over time, this can lead to tightness of the muscles and an inability to achieve full range of motion.


Rotator Cuff Tear Test and Diagnosis


Diagnosis of a rotator cuff tear depends on several factors. A thorough history should provide information regarding a possible cause of the tear. Rotator cuff tears are one of the most common shoulder injuries, so healthcare providers are typically aware of the injury.


There are many special tests for the shoulder, but a cluster of three tests is deemed the most accurate to diagnose a rotator cuff tear.


The first test is known as the Drop Arm Test. The practitioner will lift your arm to 90 degrees at your side. They will then let go of the arm and have you slowly lower it down. If you are unable to control the arm then you fail the test.


The second test is the manual muscle test for the infraspinatus muscle. External rotation is the action of the infraspinatus and teres minor. It is also a stressful movement for all of the rotator cuff muscles. The test is pictured below courtesy of researchgate.net


rotator cuff tear treatment

The final test is the Painful Arc Test. You will raise your arms as high as you can at your side and note any pain. There is typically a painful arc from 60 to 120 degrees as shown below courtesy of alamy.com. 60 to 120 degrees is the range that most relies on the rotator cuff to stabilize the humeral head to allow for pain-free mobility.


rotator cuff tear treatment

Diagnosis by x-ray is not typical as the imaging will not show muscles. Sometimes bone spurs can be observed by x-ray which leads to increased likelihood of a rotator cuff tear. However, an MRI is necessary to definitively diagnose a rotator cuff tear. The MRI will also allow the provider to determine which muscle is torn and the extent of the tear.


Rotator Cuff Tear Rehab


Treatment for a rotator cuff tear should aim to maintain as much mobility as possible even if that is done passively. Any lost range of motion can take a long time to regain, so it is important to keep moving even if the motion is painful. Frozen shoulder is a possibility with any shoulder injury that causes prolonged immobility. Recovery from a frozen shoulder can take multiple years, so it is important to avoid it at all costs.


Rotator cuff tear rehabilitation should determine what movements are limited based on the muscle tear and physical exam. The exercises should be tailored to address that movement limitation. For example, if you have difficulty reaching behind your back, then it is important to break that movement down into shoulder extension and internal rotation to find where you are truly limited. Individualized care is crucial for a rotator cuff tear.


rotator cuff tear treatment