ROTATOR CUFF TEAR
The rotator cuff is made up of 4 muscles in the shoulder:
The rotator cuff is designed to keep the shoulder joint snug in the socket when moving the arm. A rotator cuff tear is fairly common and the likelihood of a rotator cuff tear increases with age. Are rotator cuff tears really a problem?
Research shows that 23% of people aged 50+ will have a rotator cuff tear. Furthermore, 51% of people aged 80+ will have a rotator cuff tear. However, the research proves that most people with a rotator cuff tear do not experience pain.
More specifically, people can show a rotator cuff tear and experience shoulder pain, but the source of pain is something other than the tear itself. This is why it’s so important to rule out everything we have listed under the symptoms section below prior to assuming the tear is the cause of shoulder pain. This is especially true if you are the type of person who wants to avoid unnecessary surgery.
Diagnose Rotator Cuff Tear
A rotator cuff tear is traditionally diagnosed using an MRI. However, ultrasound could also be used as a diagnostic tool. With that said, you cannot diagnose a muscle tear using an X-ray because an X-ray can only see bone, not muscle.
Furthermore, there are some simple movement tests that can be performed as well to diagnose a rotator cuff tear. These are:
If all 3 of these tests are positive there is a 91% chance a full-thickness rotator cuff tear is present.
A rotator cuff tear will also cause weakness and possibly pain. Our physical therapists in Durham will test the strength of each rotator cuff muscle individually to find out if it’s effected as well.
As suggested above, in our experience many people with rotator cuff tears will experience shoulder pain for a different reason other than the muscle tear. Research has proven many people without pain will have a rotator cuff tear. Therefore, many people with pain and a rotator cuff tear may not have pain due to the rotator cuff tear itself. Here are some common problems that cause symptoms similar to that of a rotator cuff tear;
Rotator cuff referred pain: This is the most common problem we see at our physical therapy clinic that can mimic symptoms similar to a rotator cuff tear. We diagnose this problem by gently pressing on each rotator cuff muscle and a positive test occurs when a client reports symptoms into the shoulder or arm in a similar area as the original complaint of pain. Treatment for this problem is myofascial release, dry needling, and an individualized exercise prescription.
Stiff cervical spine (neck): We have found that many people with shoulder pain also have a stiff cervical spine. A stiff neck can cause shoulder pain. More specifically, if a stiff spine is part of the problem there will likely be limited mobility with extension (looking up), rotation towards the painful shoulder, and side bending towards the painful shoulder. An individualized exercise prescription can fix this problem.
Stiff thoracic spine (mid spine): The shoulder joint works in close contact with the mid spine. This should make sense because the scapula (shoulder blade), which is part of the shoulder joint, sits on directly on the ribs that attach to the mid spine. If the mid spine is stiff it can force the shoulder joint to become hyper mobile and cause shoulder pain. This is especially true if there is pain with reaching overhead.
Nerve tension tests: There are 3 main branches of nerves located in the arm. These are the median, ulnar, and radialnerves. We have found that many people with nerve pain or shoulder pain have limited stretch with these nerves. This test is performed with the client lying on their back. A tight nerve is treated with instrument assisted soft tissue mobilizationand simple physical therapy exercises.
Shoulder impingement: If you have pain with reaching behind your back and reaching overhead this could be the root problem. Shoulder impingement occurs when the rotator cuff is pinched between the humerus (arm bone) and the scapula (shoulder blade) called the subacromial space. When shoulder impingement is occurring it's a sign of shoulder instabilityand can be fixed with proper physical therapy.
As you can see there are many different causes for shoulder pain. If I can give you one piece of advice it would be this: Don’t just assume a rotator cuff tear is the root cause of pain. Rule out everything listed above prior to undergoing surgery or thinking there's nothing that can be done
When is surgery necessary?
Rotator cuff tear surgery is necessary when there is a full-thickness tear that is limiting the person from using their arm. Nearly everyone we see at our PT clinic is able to use their arm, it just hurts. In other words, if the pain was gone they would feel close to 100%. A rotator cuff tear that requires surgery should cause the inability to lift or use your arm.
If you physically can’t lift your arm, rotator cuff tear surgery is likely necessary. If pain is the only limitation you have, schedule a free phone consultation so we can find out if our therapy can help you overcome the pain without surgery.
No, they don't. Research shows that 23% of people aged 50+ will have a rotator cuff tear. Furthermore, 51% of people aged 80+ will have a rotator cuff tear. However, most people with a rotator cuff will not have any pain.
With that said, the severity of the tear can be the difference between pain and no pain. The larger the tear the more likely it is to hurt.
But you'll want to be cautious when assuming the rotator cuff tear is in fact the cause of shoulder pain. There are many problems that can mimic pain similar to a tear.
The most frequent problem we see that mimics symptoms similar to a rotator cuff tear is pain referred from the rotator cuff muscles. We diagnose this by lightly pressing the rotator cuff muscles (there are 4 of them) and a positive test will cause the client to report symptoms into the shoulder.
Many people with shoulder pain will also have limited neck rotation towards the symptomatic shoulder (when compared to rotation in the opposite direction). They will also be limited in neck extension (looking up). if you have shoulder pain with lifting your arm overhead this could be the root cause.
Furthermore, mid-spine rotation will be limited in rotation towards the painful shoulder.
Finally, the shoulder is typically also limited in flexion (reaching overhead), internal rotation, and extension (reaching behind), when compared to the non-painful shoulder.
Further testing should also be performed to identify if nerve tension is contributing to the pain. There are 3 main nerves in the arm (median, ulnar, and radial). This test is performed with the client lying on their back and a positive test occurs when the client reports pain or discomfort.
Many times when we improve the neck, shoulder, and mid-spine mobility back to normal the shoulder pain diminishes.
if you live near Durham, NC we can diagnose any one of these problems as a contributing factor for shoulder pain in a single visit.
Perhaps nothing. But perhaps the tear and pain get worse. We would advise you to not leave a rotator cuff tear untreated. This doesn't mean you need surgery. Physical therapy should be able to improve shoulder pain and prevent further damage.
Find a physical therapist (or another specialist) who assesses movement in your neck, shoulder, and mid-spine, for any contributing factors that cause shoulder pain.
That depends on what solution you're looking for. If you want to give yourself the best possible chance to avoid surgery, pain meds, and cortisone injections then we're the people you want to see.
With that said, if you're unable to lift your arm overhead then surgery may be necessary. If you can lift your arm overhead, but it's painful then we can likely save you from surgery.
That depends on what you mean by 'fix'. Can physical therapy fix the tear? Probably not. But physical therapy can typically fix the pain and provide a long-term solution.
With that said, the literature shows that many people who have rotator cuff surgery will later have another tear. If you don't fix the movement problems that led to the tear in the first place then your chances of having another tear (or worsening the tear that's already present) increase.
They won't fix the tear but they can decrease the shoulder pain. However, cortisone shots have been shown to cause cartilage damage and tendon weakness. Cortisone shots should be avoided if at all possible. And when they are administered it should be combined with rehab so the pain doesn't return when the shot wears off.
There are 2 separate scenarios that can cause a rotator cuff tear.
Typically, a traumatic injury that causes a rotator cuff tear will be a fall on an outstretched arm.
A non-traumatic tear can result from repeated stresses over time.
Our physical therapy clinic specializes in treating non-traumatic injuries. Most of our clients are unaware of an exact cause that lead to their symptoms. If this is your case then find someone who doesn't just asses the shoulder joint and rotator cuff. Many times shoulder pain (rotator cuff tear or not) can be a result of a problem occurring at the neck or mid-spine.
When someone can't physically lift their arm overhead then a tear is likely to require surgery. Conversely, if you can move your shoulder in all directions but pain is present then surgery is unlikely to be necessary. A physical therapist should be able to help you overcome the pain.
Furthermore, if someone comes to our clinic and isn't seeing any positive results after 4-5 sessions then surgery may be the next step. Most times we can begin to improve symptoms within the first visit.
There is no one best exercise. It all depends on where the pain is felt and what movement dysfunctions are present. However, there should be a progression for rehabbing a rotator cuff tear.
Typically, the pain will be felt in the front or top of the shoulder. All 4 of the rotator cuff muscles attach here and therefore, the pain is generally felt in this area.
Wondering if our physical therapy clinic is the right approach for your problem?
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