The rotator cuff is a group of four muscles and their tendons that play a crucial role in shoulder movement and stability. These muscles form a “cuff” around the glenohumeral joint – the ball and socket joint that connects the upper arm to the shoulder blade.
What is the rotator cuff?
The rotator cuff consists of 4 distinct muscles that form a “cuff” around the shoulder joint:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Together, they help stabilise the shoulder joint and enable essential movements such as lifting, rotating and raising the arm; movements that are essential for activities of daily living.
Causes of rotator cuff tear
- Acute injury: A sudden fall, lifting a heavy object, or a traumatic event
- Repetitive use: Over time, repetitive overhead movements such as those performed by athletes or manual labourers can lead to tears due to reduced or lack of time to heal
- Age-related degeneration: tendons weaken and become less elastic with age
Aging and rotator cuff tears
Due to the natural changes that occur as we age, the properties of the tendons also change making them more prone to injury. Alongside the physiological changes, there are other factors such as loss of muscle mass and strength, bone changes, reduced blood supply and changes in activity levels that can contribute to the development of tears. Many people have tears that are asymptomatic and go unnoticed. However, statistics show:
- 25% of people over 65 years will have a rotator cuff tear
- 50% of people over 80 will have a rotator cuff tear
- Among individuals over 60 with a symptomatic tear, there is a 50% chance that they may have an asymptomatic tear on the opposite shoulder
Symptoms
- Dull ache in upper arm and/or shoulder
- Weakness in the arm
- Difficulties lifting the arm above shoulder height due to pain/weakness
- Disrupted sleep, pain lying on affected side
These tears can range from small partial tears to complete ruptures, and it can involve 1 or more of the muscles. It is important to note that the severity of symptoms is not a good indicator of the severity of injury.
Imaging
The shoulder is a complex joint; thus it can be difficult to delineate which structure is causing your symptoms. Not everyone requires a scan, especially if the diagnosis is clear based on history and clinical examination. However, in some cases, it can assist in determining the specific structures involved and their severity.
Imaging options include:
- X-ray: first line in traumatic events to rule out fracture or joint abnormalities. Cannot visualise soft tissues.
- MRI (magnetic resonance imaging): Gold standard. Provides detailed images of tendons, muscles and joint structures. Can assess tear location, size and severity.
- Ultrasound: Useful, cost-effective, and dynamic, but may not detect all tears – less reliable than MRI
Treatment options
Several treatment options are available for rotator cuff tears, and the appropriate approach often depends on factors such as the patient’s age, the severity and type of the tear, and their functional activities and goals. In many cases, shoulder pain and function can improve significantly with conservative (non-surgical) management.
Conservative treatment through physiotherapy is typically the first line of care and focuses on symptom relief, restoring shoulder function, and preventing further injury. Common strategies include targeted exercises to strengthen the rotator cuff and surrounding muscles, improving shoulder range of motion, and modifying activities to avoid movements that aggravate the condition. Manual therapy is often used to relieve the joints around the neck and shoulder which can help with night pain. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation; however, in the case of acute injuries, delayed use is recommended as they could potentially interfere with early healing.
Studies have demonstrated that many individuals, especially those with degenerative rather than traumatic tears, experience substantial improvements with conservative treatments alone.
Surgical opinion is usually considered only if you have not had success with consistent conservative treatment and,
- <60 years of age
- Traumatic incident
- 1 or more tendons are involved
- Higher functional demand (e.g. overhead activities)
If you experience shoulder pain and are unsure on what to do or have been treated in the past but have recurring episodes of shoulder pain. Please get in contact with our Physiotherapists here at Bend + Mend as we would love to help you out.
