A rotator cuff tear is one of the most common shoulder injuries that can occur. This is due to the natural instability that is present at the shoulder joint. The role of the rotator cuff is to support the smooth and controlled movement of the glenohumeral joint. The shoulder is comprised of three main structures. The scapula, the clavicle and the humerus. The rotator cuff lays between the humerus and the scapular and aids mainly with rotation around the shoulder joint.
There are two main causes why a patient would suffer with a rotator cuff pathology.
In most cases, the cause of damage to the rotor cuff is likely to be degenerative. Several of these factors are what lead to pain although a large percentage of people will have some damage to the rotator cuff once that are age 40+ but will not feel any pain therefore the injury will heal naturally.
Repetitive stress – overuse is a typically the explanation to why there may be damage in your shoulder. By continuing to use the same movement for either work related activities or for sport, you cause these structures to become fatigued and overworked. For example, repeating a tennis serve or swimming movement, in particular activities that because of overhead movements tend to provoke symptoms.
Bony spurs – as we age bone spurs can form in areas where we need space for pain free movement. With this pathology, under the acromion bone tends to be the most common site, from here the spurs cause friction with the tendons of the rotator cuff.
Lack of blood supply – with age comes a reduction in blood circulation to the tendons of the rotator cuff. Without adequate blood supply, the body’s natural process of healing is longer therefore there is more chance that damage can occur.
The seconds type of cause of rotator cuff damage is mechanical injury from a fall or accident. If you fall on an outstretched arm or lift something too heavy with a jerk motion involved there is a chance you have damaged the rotator cuff.
There are the most common symptoms you would be likely to have with damage to the rotator cuff are:
- Crepitus or a cracking feeling when moving your shoulder into certain positions
- Pain when lowering and/or raising your arm or with specific movements.
- Weakness when rotating the arm as well as lifting
- Difficulty sleeping and pain when laying on the affected side.
Tears that happen suddenly from a fall or twisting incident usually begin with intense pain and there may be a cracking sensation and initial weakness at the time or shortly after injury. Tears that are a result of overuse or degenerative changes may show slightly different symptoms, the location of pain in this type of scenario would likely present with a pain when lifting your arm, the pain can sometimes move down the arm at first, it may be mild.
The majority of patients with a rotator cuff tear will recover without the need for surgical treatment.
Non-surgical options may include:
Rest – resting and not continuing to use the shoulder in motions that are painful (protect the shoulder by immobilising)
Activity modification – modify the activities that you are undertaking to make them manageable so that they do not cause your symptoms to flare up.
Strengthening exercises – specific exercises will aid the return of movement and strengthen your shoulder. That may include stretches to improve flexibility and movement as well and strengthening the stabilising muscles of the shoulder.