Rotator cuff tears are a very common cause of pain and if left untreated can lead to disability. The rotator cuff is made up of four muscles the Supraspinatus, Infraspinatus, Teres minor and the Subscapularis. The purpose of the rotator cuff is to help keep your arm stable in the shoulder socket. A partial rotator cuff tear is defined as any one of these four muscles being partially torn but not severed. A full thickness tear is where the tendon to any one of these muscles is fully torn.
Rotator cuff tears usually develop without any trauma and most people are unaware of how they injured their shoulder. Tears also may occur if a person is performing overhead activities on a daily basis. An example of this would be a construction worker, a manual laborer or a person whose occupation requires them to paint walls and ceilings. Most often, a person will report shoulder pain and weakness while performing activity that involves moving their shoulder. For some patients a full rotator cuff tear can be caused by trauma, but this is not typical.
There are several risk factors for developing a rotator cuff tear. Individuals who are very active and perform overhead activities on a daily basis are at a greater risk for developing a rotator cuff tear. People over the age of 40 are at greater risk for developing a tear as well. Also people who have poor posture or people who have bone spurs in the shoulder are at greater risk for developing a tear.
When a person initially tears their rotator cuff they will usually experience a large amount of pain during the time of the injury. People with rotator cuff tears will often complain of stiffness, pain and local tenderness of the shoulder. Individuals may also have pain while lifting the arm above their head or have difficulty doing so. Weakness of the shoulder usually occurs in full thickness tears.
For a partial rotator cuff tear a physical therapist will focus on prescribing exercises that focus on strengthening the rotator cuff muscles and the muscles that surround the shoulder blade. Postural education will be provided to the patient as well. A physical therapist will also incorporate hands on techniques that place the shoulder joint in various positions that stretch the shoulder joint. As a patient progresses a therapist will begin incorporating exercises that place the patient’s shoulder in pain free overhead positions.
Although the overall prognosis for a full rotator cuff tear is not nearly as positive as a partial tear, some people do quite well with conservative management. For patients will full rotator cuff tears shoulder range of motion deficits tend to be more prominent and this is mainly due to significant weakness of the shoulder. Because of this, a physical therapist will focus more on compensation strategies. Because one or more of the rotator cuff muscles have been torn they will not be able to function, thus other muscles must be used to control and move the shoulder. The therapist will continue strengthening the rotator cuff muscles that are still intact, but they will also incorporate exercises that strengthen the more superficial shoulder muscles (i.e. the upper traps and deltoid). If these superficial muscles are strengthened enough they can adequately compensate for the torn rotator cuff muscle(s).
A patient may elect to have surgery if they have sustained a full rotator cuff tear and are very active or if their occupation requires lifting heavy objects overhead. However, even if a person decides to have surgery physical therapy will still be required afterwards. After surgery pain and inflammation will initially restrict the range of motion of the shoulder. Thus the therapist will initially focus on restoring the range of motion of the shoulder be stretching the muscles around the shoulder joint. After shoulder range of motion has been restored the therapist will focus on strengthening all of rotator cuff muscles. Lastly the therapist will begin focuses on exercises that strengthen the shoulder in overhead positions so they can return to work activities and any activities that they were performing prior to the injury. It’s important to note whether a person decides to have surgery or attempt conservative management physical therapy will often be required.
Whether you are experiencing shoulder pain or shoulder weakness make sure to stop by Total Performance Physical Therapy for an evaluation today.
