Rotator Cuff Injury

What is the Rotator Cuff?

The rotator cuff is a group of four muscles that provide stabilisation & support to the shoulder joint. A cuff injury refers to an injury of the cuff muscles or their tendon insertions onto bone.

Rotator cuff injuries will commonly result in pain with activities involving lifting or pushing. In more severe cases, pain will be present at night & may cause the person to wake.

The shoulder is a ball and socket joint that is capable of extreme mobility. As a consequence of this mobility the shoulder is inherently less stable than other joints.

The cuff muscles have an important role in shoulder stability through their action in compressing the top of the arm bone (humeral head) into the shoulder socket. Injury to any of these important support structures can give rise to instability of the shoulder joint and this may cause pain with movement.

Conditions affecting the shoulder cuff muscles may include acute or chronic tears & tendinopathy. An acute tear usually occurs as a result of a trauma in younger people.

Tears can be either partial thickness or full (complete tendon tear). Clinically, there may be severe pain, weakness and a significant decrease in motion. Tears can be diagnosed using ultrasound.

KFM Radio Interview
Ross Allen from Naas Physio Clinic discussing Rotator Cuff Injuries:

Causes of Rotator Cuff Tears

Injury to the rotator cuff may occur due to poor lifting technique, muscle imbalance or repetitive activities.

In my experience, the most common type of person we see here at Naas Physio Clinic with a Rotator cuff injury have an older age profile and often have occupations requiring overhead positions, such as painters or plasterers. 

Some people can be predisposed to rotator cuff tears owing to the angle of the socket into which the top of the arm bone (humerus) sits. If this slops upwards it is more likely to hang over the top of the bone and this can predispose to injury.

Surprisingly, many people present with an onset of pain but no prior history of trauma. Even if there is a particular incident associated with the pain, it is often fairly innocuous.

As the study below shows, a huge proportion of individuals over the age of 60 have rotator cuff tears.

Chingford Study: How common are rotator cuff tears in those without shoulder pain?

Small Rotator Cuff Tears Do Not Necessarily Cause Shoulder Pain:

The repeated overhead forceful motion involved in baseball has been implicated in the presence of cuff tears in players. In a study of baseball players it was found that shoulder pain did not differ between baseball players with rotator cuff tears and those without tears. Among the 41 players with tendon tears, only 7 had shoulder pain. This compares to 9 of the 46 players without tears on ultrasound testing. The authors report that partial-thickness tearing of the rotator cuff is not linked to shoulder pain during throwing

Rotator Cuff Tendinopathy

Most people with rotator cuff tendinopathy will report a gradual onset of pain. Most cases occur in those over 40 years of age & patients will often report pain lying on the affected side.

Surgery for the Shoulder

Recent research suggest that there is no difference between non-surgical and surgical management of  rotator cuff tears.

The theory of shoulder impingement by bony structures has not proven to hold up to scientific scrutiny and this may undermine the the supposed mechanism by which surgery is supposed to exert its effects. This has led to suggestions that surgery may act as a placebo or benefits may arise due to greater adherence to rehabilitation protocols used after surgical interventions.

What about large Rotator Cuff tears greater than 5cm?

Improvements with larger tears can be achieved with Physiotherapy guided rehabilitation. From a surgical perspective, tears over 5cm are often not reparable or, if repaired, have a high rate of failure.

Factors that will impact on the success of cuff repair surgery include: their age, the size of the tear and the amount of muscle wasting. If these factors are not favourable then there is a high probability that the tendon will not heal post surgery. Generally, large tears are considered irreparable due to the low level of success

Rehabilitation for Shoulder Cuff Injury

Rehabilitation of the shoulder commences with low level exercises & progresses sequentially through stages of increasing difficulty. Exercises focus on the cuff muscles & also incorporate the upper back and shoulder blade.

Posture at the thoracic spine (upper back) & neck can play an important role in determining the angle that the shoulder socket sits at & therefore can significantly alter the movement quality & muscle activation patterns present at the shoulder. Over time this can place pressure on the tendons of the shoulder & give rise to tendon overload and tearing.

Other treatment modalities include soft tissue release techniques, joint mobilisations, & dry needling. Pain during shoulder movements can occur due to superior migration of the head of the humerus (arm) in the shoulder socket.

The aim of the rehabilitation programme is to strengthen the cuff muscles in order to prevent abnormal translation of the humerus and to gradually increase stability. 

Because the head of the humerus (arm) is drawn upwards when a cuff tear is present, part of the goal of rehabilitation is to strengthen the muscles that draw the arm downwards. This involves strengthening muscles, including the lattisimus dorsi and teres muscle groups.  

Challenging shoulder flexion, both to maintain strength and improve function, are a vital part of the rehabilitation process. Ainsworth (2006) implemented a progressive anterior deltoid strengthening programme for treatig individuals with large rotator cuff tears. 

This process requires persistent effort from the patient & it can take a number of months to recover from this injury. Consistency is the key to bringing about an improvement in shoulder function.

References:

Mihata T, Morikura R, Hasegawa A, et al. Partial-Thickness Rotator Cuff Tear by Itself Does Not Cause Shoulder Pain or Muscle Weakness in Baseball Players. Am J Sports Med. 2019;47(14):3476-3482. doi:10.1177/0363546519878141. https://pubmed.ncbi.nlm.nih.gov/31609639/

To find out more regarding Rotator Cuff Injury, contact the Physio Clinic Naas & Newbridge now on:
(045) 874 682
or email us at info@physioclinic.ie[/vc_column_text][/vc_column][/vc_row]