Rotator cuff tear
The rotator cuff is term used to describe a group of muscle that support the shoulder and allow for proper shoulder positioning and motion. The rotator cuff group is both a sensory and motor ‘organ’ that controls optimal position, motor control and coordination of the shoulder. There are four muscles that make up the rotator cuff and these are call the supraspinatus, infraspinatus, teres minor and subscapularis. At rotator cuff tear of the shoulder describes a tear in one of those muscles or their tendons (joins a muscle to bone). This can be a complete tear or a partial tear. The supraspinatus is the most commonly torn muscle of the rotator cuff. Most rotator cuff tears will not need surgery, however an experienced chiropractor or physiotherapist must complete an individualised clinical assessment of the shoulder. The presence of a tear on MRI (MR arthrogram) does not necessarily mean someone will need surgery, especially if they are over 50 years of age.
Furthermore, we are all likely to get disruption to our rotator cuff tendons as we age. Thats right, I’m going to say that again and in a different way. Rotator cuff tears are common, typical and some authors will say normal. Most will not lead to pain, discomfort and/or problems. In fact in many cases are only found my accident after hurting our shoulders when we get an MRI. Therefore it is easy to look at a MRI and blame tears for all our problems but in reality they have been there for years and years without causing issue. Now in saying all of that, of course some rotator cuff tears are acute, painful and big problems. The trick is to find a chiropractor or physiotherapist that knows the shoulder really really well and can perform a battery of tests on the shoulder that confirm exactly what is wrong with the shoulder.
The false positive results in ‘just’ looking at an MRI to diagnose shoulder problems are HUGE. If your practitioner has done this without shoulder testing it could be likely that you have been misdiagnosed.
Symptoms of rotator cuff tear
Rotator cuff injuries and tears are a very common injury and will typically present with:
- Pain at night (and rest)
- Pain worse with compression such as lying on it
- Pain on shoulder movements (contracting muscle)
- A painful arc (sore in certain movement positions like over head)
- Inability to move upper arm (for acute and sudden large tears)
Rotator cuff tears can send pain down the arm and it is important that you see a chiropractor or physiotherapist to make sure your neck is also not involved as this is common and can lead to serious complications in your shoulder recovery. Many neck problems refer to the shoulder and behave like rotator cuff tears. As silly as this may sound, it is important to have your neck screened.
Causes of rotator cuff tear
The causes of rotator cuff tears are typically grouped in two distinct but related categories: Acute rotator cuff tears and degenerative rotator cuff tears.
Acute rotator cuff tears occur as a result of an injury. Common injuries that are typically associated with a rotator cuff tear are:
- A fall on an outstretched arm (FOOSH injury)
- Pulling or lifting a heavy object
- Shoulder dislocated or breaks
- Sporting injury such as rugby or contact sports
Degenerative rotator cuff tear occur when the tendons become worn down over time and the ageing process. This is considered a normal part of ageing and is more common in the dominant arm as this is used more throughout life. These types of tears may or may not produce pain. Common risk factors for getting a degenerative or chronic tear include:
- Age. We will all age, and as we do the blood supply to the rotator cuff reduces. Without blood there is no healing. Little tears and inflammation no longer heal and add together to form tears.
- Overuse. This is just an accumulation of repetitive stress, over time continuous bouts of microtrauma in the tendons and muscles wears them down and tears develop. This is common in overhead athletes like tennis players and baseball pitches.
- Anatomy. Some people will have bones in the shoulder that rub more on the rotator cuff and slowly wear it down (type III acromion). As we age we can also develop bone spurs and these may also rub on the rotator cuff. In both instances rotator cuff tears are more likely to develop.
Treatment of rotator cuff tear
At Sydney Spine & Sports Centre (S3C) treating shoulder pain is our passion. It is estimated that around 50% of people will get better without surgery. The way our chiropractors and physiotherapists will treat your shoulder pain will largely depend on which type of tear it is. Ultimately our chiropractic and physiotherapy treatments for rotator cuff tear will aim to reduce pain and restore function. For acute tears, there is a large focus on reducing the pain and inflammation associated with the tear and for degenerative tears that are symptomatic improvement is a key goal. For both acute and chronic tears strengthening that rotator cuff and making it more tolerant to load and movements is the ultimate goal to treatments.
The important thing to note with any rotator cuff tear is that everyone is different, will have different shaped shoulder bones, tears in different places, be different ages and have different lifestyle and activity goals. It is important to seek a personalised treatment that is individualised to your specific case. At Sydney Spine & Sports Centre (S3C) our chiropractor and physiotherapists will do this with each and every patient.
Please read these articles on common shoulder problems for greater understanding
- Shoulder pain overview
- Biceps tendon tear in shoulder
- Chronic shoulder instability
- The unstable painful shoulder
- The weak painful shoulder
- The stiff painful shoulder
- Shoulder impingement
- Dislocated shoulder
- SLAP tears of the shoulder
- Arthritis of the shoulder
- Biceps tendinitis of the shoulder