A rotator cuff tear is when the tendon that connects the muscles of the shoulder blade (scapula) to the arm bone (humerus) is partially or fully torn.
What is the rotator cuff?
The rotator cuff is composed of 4 different muscles: the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles all have individual actions to control the movement of the shoulder, but their main role is to work cohesively to keep the head of the humerus in the shoulder socket.
How does a tear happen?
A tear can happen through a single trauma or natural changes due to ageing.
When the tendon is placed under too much tension, it can tear. This can occur when landing awkwardly on your arm or lifting a heavy object. A rotator cuff tear can occur in conjunction with other injuries such as a broken collarbone or dislocated shoulder.
Overtime, tiny tears develop in the tendon, which may contribute to pain and weakness. Rest assured, these are normal changes due to ageing. Much like grey hairs and wrinkles, the rotator cuff tendon changes as we age with about 54% of patients aged 60 years and over having a tear of the rotator cuff tendon. Repetitive friction of the tendon can also cause these changes. It is more common in people who do repetitive overhead arm motions in sports like baseball or tennis, or in jobs of painting or cleaning windows,
“…the rotator cuff tendon changes as we age with about 54% of patients aged 60 years and over having a tear of the rotator cuff tendon…”
How do you know if you have one?
Some signs of a rotator cuff tear are:
- Shoulder pain when raising arm
- Muscle weakness causing difficulty when raising your arm or lifting objects
- Difficulty and weakness when raising arm or lifting objects
- Pain when lying on the side
- Pain when sleeping or waking at night.
Tears can be identified on an MRI (magnetic resonance imaging) scan, but an MRI is not always necessary. However, you can have a rotator cuff tear without any symptoms. A study done by Tempelhof, Rupp & Seil looked at people with no shoulder symptoms. On MRI, 23% of 411 people had a rotator cuff tear. The study also found that 13% of patients aged 50-59 had a tear, 20% aged 60-69, 31% of patients age 70-79 and 51% of patients older than 80 had a tear.
A physiotherapist can conduct a series of tests such as palpation, range of motion tests, strength tests and provocative tests to reproduce the symptoms to identify a tear.
If not managed correctly, a rotator cuff tear can be a source of persistent pain, limit your function and lead to further degeneration of structures in the shoulder.
If you are experiencing any of these symptoms, physiotherapy can help.
Following a rotator cuff tear, there are two pathways of management:
- conservative management or
- surgical repair.
In most cases, conservative management can restore shoulder function and minimise pain. In both pathways, physiotherapists are involved in creating a tailored treatment plan to help you get back on track and achieve your goals.
Clement, N. D., Nie, Y. X., & McBirnie, J. M. (2012). Management of degenerative rotator cuff tears: a review and treatment strategy. Sports medicine, arthroscopy, rehabilitation, therapy & technology: SMARTT, 4(1), 48. https://doi.org/10.1186/1758-2555-4-48
Itoi, E. (2013). Rotator cuff tear: Physical examination and conservative treatment. Journal of Orthopaedic Science, 18 (2), 197-204. doi:10.1007/s00776-012-0345-2
Lambers Heerspink, F. O., van Raay, J. J., Koorevaar, R. C., van Eerden, P. J., Westerbeek, R. E., van ‘t Riet, E., van den Akker-Scheek, I., & Diercks, R. L. (2015). Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: A randomized controlled trial. Journal of shoulder and elbow surgery, 24(8), 1274–1281. https://doi.org/10.1016/j.jse.2015.05.040
Tempelhof, S., Rupp, S., & Seil, R. (1999). Age-related prevalence of rotator cuff tears in asymptomatic shoulders. Journal of shoulder and elbow surgery, 8(4), 296–299. https://doi.org/10.1016/s1058-2746(99)90148-9