Rotator cuff tear
What is it?
The rotator cuff muscles are a group of 4 muscles that help move your shoulder. They work together to help get your arm above your head, rotate your arm in and out and help keep the ‘ball in its socket’.
The rotator cuff comes from the shoulder blade to attach onto the ball of the humerus. The diagram below illustrates how they run underneath a bone called the acromion and at this point they can be very vulnerable to damage.
Damage can either occur from a sudden injury or can be due to weakening of the tendons due to surrounding inflammation or “wear and tear”. As you get older the tendon becomes weaker and there is an increased chance that damage can occur gradually.
When the tendons are damaged this can cause a lot of pain and can also prevent moving the arm especially above the head or rotating the arm in and out.
How can physiotherapy help?
Conservative management- If surgery is not indicated, physiotherapy helps by strengthening the other muscles around the shoulder, increasing your movement, flexibility and helping to improve all functional activities. This helps to decrease the pain, symptoms and increase the strength in your arm. Full recovery can take up to 3 months plus.
Pre-op Physiotherapy- This helps to increase the flexibility of your shoulder, improve the strength of the other muscles in your shoulder and improve your posture before surgery. This puts your shoulder in the best physical state to help with your rehabilitation after surgery.
Post-Op Physiotherapy- Physiotherapy is essential to gradually return your shoulder back to full function, working on strength and flexibility. This stage also helps you return to work, sport or general activities of daily life in a gradual way. This process can take up to 9 months.
Once a tear in the tendon has occurred the muscle retracts and so often the tendon will not heal. The tear may be confirmed by ultrasound or MRI scanning. Depending on these results as well as other factors such as general health, pain and loss of function, surgery may be offered.
Surgery is performed to repair the tendons. This may be performed through a 5cm wound on the outer side of the shoulder or more commonly through a keyhole method (arthroscopic) with several very small wounds.
During surgery the tendons are cleaned and released from any scar tissue. If the tear is very large or has been present for a very long time the muscle may be too contracted to allow the repair to be made. The tendons are reattached to the bone with small “anchors” and stitches.
At the time of surgery any wear and tear changes are also dealt with, and a “decompression” of the shoulder may also be performed. This involves shaving off any boney spurs that may have developed and that if left alone could cause further pain and damage to the tendons.
After surgery a sling is usually prescribed for several weeks, this is to protect the repair. Following this physiotherapy will be required to allow both range of motion and strength to be regained.
Recovery from this operation may take 6 to 9 months, and analgesia will be required to allow the exercises to be performed. Most patients achieve a good functional range of movement in the shoulder and have significant reduction in their pain.
Targets for recovery should be:
Washing unaided: 2- 3 weeks
Driving: 6 – 8 weeks
Golf: 12 weeks
Full return of function: 6 – 9 months.