Rotator Cuff Tears

  • The rotator cuff helps stabilise the head of humerus in the glenoid
  • Rotator Cuff tears can often be asymptomatic- it is estimated that 40-50% of over 60’s will have a tear, with 70% of these being asymptomatic
  • The rotator cuff degenerates with age and is therefore, unable to cope with demands put on it- cuff tears are a normal part of aging
  • Tears can be as a result of a trauma or degenerative
  • It is not the tear that caused the pain; it is the altered biomechanics as a result of the tear which irritates the bursa/tendons and causes pain
  • Evidence suggests there is no difference in outcome between surgical intervention and physiotherapy for treatment

 

Rotator Cuff Tears

A 71-year-old male with a rotator cuff tear in the left shoulder A full thickness cuff tear is observed b/c An increase of radioisotope uptake in the left shoulder joint is observed

 

Subjective history

  • Pain on the anterior GHJ, sometimes radiating into the bicep region
  • In a traumatic tear, there can be a trauma/ incident that caused the pain to start i.e. a fall
  • In degenerative tears, the onset is often insidious, or a relatively small task can cause tear, i.e. shutting the car door and therefore, goes un-noticed by the patient
  • Often the patient is unable to elevate their arm
  • The patient often reports limitations in function such as brushing hair, putting on coat and taking their hand behind their back
  • With a full thickness tear, the patient can often present pain free, with the main complaint being unable to elevate arm and reduced function
  • Painful to lay on the affected shoulder

Objective assessment

  • Reduced active range of movement (often not pain related)
  • Passive range of movement more than active
  • Rotator cuff weakness (either through range or part range depending on location of tear)
  • Often tenderness on palpation of supraspinatus insertion or rotator cuff muscle belly

Treatment

  • If there is a history of trauma please refer to T&O’ (please refer to the shoulder pathway
  • Modified rest

Referral for physiotherapy treatment to focus on improving;

  • Active range of movement
  • Rotator cuff strengthening
  • Scapular stability
  • In cases where a full thickness tear is suspected, the Anterior Deltoid regime will be given, whereby we work the deltoid to compensate for lack of power in the cuff

Physiotherapy can refer to secondary care if failure to improve despite being compliant with a rehabilitation programme and conservative management over a period of 3-6 months

 

References

  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC
  • Image from OpenI – Licensed by CC

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