Torn Rotator Cuff
By Alex Bigale, PTA
Torn Rotator Cuff
The shoulder is a ball (humeral head) and socket (glenoid/labrum) joint that allows a person to have multidirectional movement of the arm. This joint is held into place by a group of 4 muscles and tendons called the rotator cuff: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. These muscles provide support for the shoulder as well as assisting with movements such as abduction, external rotation, and internal rotation. The most frequently torn rotator cuff muscle is the supraspinatus due to its position. This muscle crosses a site under the acromial-clavicular joint when bone spurs typically occur.
Symptoms of a Torn Rotator Cuff
- Pain on the outer portion of the shoulder
- Difficulty/pain when trying to sleep on that shoulder
- Pain with overhead movements
- Cracking/popping sensation with arm movements
- Weakness or inability to lift or rotate the arm
Types of Torn Rotator Cuff
Full thickness- This occurs when there is a complete tear of the muscle, separating the tendon from the bone. This is also called a complete tear.
Partial thickness– The tendon has damage or wear and tear, however still connects to both the muscle and the bone.
Acute Tear– Usually caused by trauma such as a fall, in addition can be caused by a quick movement or heavy lifting.
Chronic Tear– AKA degenerative tear, occurs over time as the tendon wears down. Degeneration occurs as we age, but other factors can speed up the degeneration and make some people more susceptible to this type of tear than others.
Repetitive stress– Occurs with chronic overhead motions from activities such as baseball/softball, tennis, rowing, and weight lifting.
Bone spurs– These bone overgrowths typically occur on the underside of the acromion. They rub on the tendons of the RTC as we move our shoulder. Over time this will wear down the tendon and make it more likely to tear.
Reduced Blood Supply: If the tendons of the RTC do no receive adequate blood supply for prolonged periods of time, then they are not getting the healing factors to help repair small tears that occur.
How to Diagnose a Torn Rotator Cuff
Confirming a diagnosis of a torn rotator cuff can be performed through a physical exam as well as imaging. Specific tests, which will measure your strength and range of motion, will be performed by your physician to help rule out any other possibilities. Most physicians will want to perform an MRI to confirm the tear. In addition, calculate the size and significance of the possible tear to determine the treatment options.
Non-Surgical/Conservative- Most physicians will attempt to prescribe non-surgical treatment options as an initial approach to allow the body to heal itself. This is especially true if the patient only suffers a partial tear, or if they are not a good candidate for surgery. If a full thickness tear is present, the body can be trained to have functional use of the arm. This is true if the pain and inflammation are managed.
Non-surgical options include:
- Anti-inflammatory medications
- Steroid injections
- Physical Therapy
Surgical/Operative Management- With surgical advancements, recovery time and ability to regain function has greatly improved over the years. The surgeons at Jacksonville Orthopedic Institute are using the latest technology and up to date on research, which allows them to perform RTC repairs where the attachment of the tendon to the bone is stronger and gives a patient a better chance of regaining full function and reducing risks of re-injury.
Following a rotator cuff repair surgery, a patient can expect to begin physical therapy (PT). The initial phase of PT should consist of passive range of motion performed by the therapist to minimalize joint stiffening which would cause problems down the road. Once the surgeon determines that the healing process is far enough along, the patient will begin working on active range of motion, followed by strengthening exercises.
JOI’s goal is to help improve the performance of athletes to reduce the risk of injury or re-injury. All of our rehab centers are certified to assist in rehabilitation from a torn rotator cuff muscle. If you have the condition or symptoms of a rotator cuff tear and would like to make an appointment with our staff please call (904)346-3465.