What is it?
The rotator cuff is a group of four small muscles that surround the shoulder joint. Their tendons attach to the humerus close to the joint line, acting as a cuff that supports and controls the shoulder. Their primary role is to stabilise the joint, keeping the head of the upper arm bone centred, and they also help produce rotational movements.
These tears are common and can occur in any of the four muscles. They usually happen within the tendon itself, most often the supraspinatus, near where it attaches to the bone, an area with a relatively poor blood supply. Common in racket and throwing sports, they are a leading cause of shoulder pain, and become more prevalent with age due to degenerative changes in the tissues.
What are the symptoms?
Many people have rotator cuff tears with no symptoms and are unaware of the injury. For others, they can be very painful and make the shoulder difficult to move, particularly overhead. The arm may feel weak with a restricted range of movement, and pain often radiates down the arm and disturbs sleep at night. Interestingly, the size of a tear does not necessarily relate to the pain and dysfunction experienced, with small tears sometimes creating large problems and large tears going unnoticed.
What are the causes?
A fall onto an outstretched hand is a common cause of acute tears, as are rapid twisting or overstretching movements. However, most tears develop gradually through age related degeneration, where everyday activities damage tendon tissue that has lost strength and elasticity over time. Other causes include overuse, lifting or carrying heavy objects and repetitive overhead activities. Poor biomechanics and a reduced blood supply over time can weaken the tendons, leaving them more susceptible to injury. This is a significant factor in both the development of tears and recovery outcomes.
How can physiotherapy help?
The main objectives of physiotherapy are to reduce pain, increase range of motion and strength, and improve shoulder function. Your physiotherapist will help you set goals and reach them with a targeted rehabilitation program, manual therapy and education to get the most from your recovery. While some tears are repaired surgically, research increasingly shows that for many tears, including some larger degenerative ones, a comprehensive rehabilitation program can achieve outcomes comparable to surgery. For this reason, a conservative approach is often recommended as the first treatment option. The time frame for recovery varies from person to person and depends on factors including whether surgery was chosen, the severity of the injury and function beforehand.
None of the information in this newsletter is a replacement for proper medical advice. Always see a
medical professional for advice on your individual injury.