What is it?
The rotator cuff muscles are important for shoulder stability and control, but as a result of their location and the demands placed on them, the tendons are susceptible to wearing out – resulting in degenerative partial thickness tears. The condition primarily affects middle aged and older adults, with the prevalence increasing in aged populations. Tears to the rotator cuff muscles are one of the most common conditions presenting at the shoulder.
What does it feel like?
It is usually described as a gradual onset of pain/stiffness and dysfunction of the shoulder joint with no history of trauma. The pain is often located at the front and slightly towards the side of the tip of the shoulder. Pain is usually constant but is exacerbated with overhead activities. Weakness and loss of range of motion are also common complaints.
What causes it?
The causes of degenerative tears are suggested to be multifactorial with intrinsic and extrinsic factors involved. Intrinsic factors refer directly to the age-related metabolic and vascular changes of the muscle and external factors refer to the external structures, such as the shape of your shoulder structures or the strength or length of your muscles and suggest that the degeneration leading to the tear is secondary to subacromial impingement. These changes in the makeup of the of the muscle and tendons and continual impingement weakens it and leads to partial tears when the muscle is loaded. The pain and loss of strength in the rotator cuff muscle due to the tear reduces its ability to control your shoulder leading to pain with elevation movements.
Persistent shoulder pain affects as many as 20% of the general population with this number increasing to around 50% for those in the 55-64 year age bracket.
A physiotherapist can assess and diagnosis whether you are suffering from from a degnerative rotator cuff tear. Positive physical examination signs to help confirm a rotator cuff tear include: wasting (atrophy) of the rotator cuff muscles; loss of active range of motion – particularly moving your arm up/out sideways (abduction); weakness or pain signs on shoulder special tests; and also possible positive impingement signs. Medical imaging such as ultrasound and MRI may also be used to confirm the diagnosis.
What can I do about it?
Conservative management (non-surgical management) is suggested to reduce pain and inflammation in the early stages with initial rest, avoidance of provoking activities and a short course of anti-inflammatory medications – NSAIDS. A stretching program for the shoulder capsule should also be commenced. After pain is reduced and movement is restored, strengthening exercises should then be prescribed with aims to strengthen and improve control of the rotator cuff, especially the supraspinatus.
Things to do to get started once symptoms have settled:
Lie on your stretching side, so that your shoulder blade is supported on the bed. Bring your arm out 90 degrees and bend your arm. Allow your shoulder to rotate so that your wrist moves towards the bed. Use your other hand to increase stretch if needed. No pain only slight stretching discomfort may be felt.
If this position is uncomfortable, you can stretch the arm across in front of your body while sitting or standing instead.
Use a resistance band or your arm for resistance. Stand with elbows bent and relaxed on the side. Turn your arm across your body while keeping your elbows on the side. Slowly return to starting position.
Use a resistance band or your arm for resistance. Stand with elbows bent and relaxed on the side. Rotate your arm outwards. Keeping your elbows close to the body. Slowly return to starting position.
Most patients improve with conservative treatment over 6 months though improvements can continue to occur for up to 18 months. If 3 to 6 months of conservative management has failed to provide an improvement in symptoms, surgical interventions with the aim to address the pathology and pathogenesis of the partial tear are suggested. A rotator cuff repair is the favourable option for reducing pain and improving function.