The rotator cuff is a group of muscles that stabilize, control, and move the shoulder joint. One of the most common causes of pain within the shoulder is associated with the rotator cuff tendons. These include tears, calcific tendonitis, and subacromial impingement.
Given that the shoulder joint performs a wide range of motions, tears of the rotator cuff tendons are common and come about due to rapid twisting, causing over stretching the joint. There are four muscles that are collectively known as the rotator cuff. These include the subscapularis, teres minor, infraspinatus, and the supraspinatus.
The following detailed anatomical video explains the structure of the shoulder joint and the muscles that make up the rotator cuff.
Causes of torn rotator cuff tendons
Tears of the rotator cuff tendons can occur in two ways, either via trauma or repeated micro-trauma.
There are different symptoms of torn rotator cuff tendons depending on the severity of the injury, including:
- Pain in the shoulder and arm
- Tenderness and weakness of the shoulder
- Problems with shoulder mobility, especially moving the arm up above the head
- Audible cracking or snapping sounds during shoulder movements
- Inability to place pressure on the shoulder i.e. sleep on the affected side
If the rotator cuff injury has developed suddenly, often patients will feel intense pain, arm weakness and the sensation of the shoulder ‘popping-out’. How weak the arm is will depend on the severity of the injury.
A partial tear may only cause mild shoulder pain and arm weakness, accompanied by ‘clicking’ as the arm are is elevated. Conversely, a full tear will typically present with severe pain in the shoulder and in inability to move the elbow away from the body. In some cases, due to the severity of the tear, many of the pain receptors in the shoulder are also damaged. This can reduce the degree of pain, although movement will be significantly impaired.
When a rotator cuff tendon is torn, it is no longer fully attached to the humerus head. Most cases begin with fraying due to repeated strain. As this continues a complete tear can develop suddenly, such as lifting a heavy object.
In diagnosing a rotator cuff tear medical history and a physical examination will be preformed. Doctors will assess the shoulder area for functionality, pain, and deformation. A MIR is often needed to determine the extent of the injury and how recent it is.
This video shows the how the rotator cuff can be damaged and discusses various treatment options depending on the severity of the injury.
If the tear is small or medium, the rotator cuff tendons will generally heal successfully with appropriate physiotherapy treatment and conservative management. In these cases, non-surgical treatments will usually help to relive pain and enhance function. However, it should be noted that restoring pre-injury shoulder strength is often not possible without surgical intervention.
Non-surgical treatment options typically include a combination of the following:
The advantages of non-surgical treatments of torn rotator cuff is that the risks of surgery are avoided, such as:
- – Permanent stiffness
- – Infection
- – Lengthy recovery times
- – Anaesthesia complications
However, non-surgical treatments also have their limitations:
- – No strength enhancement
- – Tear size may still increase over time
- – Extra care is needed when performing activities that require shoulder movement and strength
Often shoulder surgeons recommend a minimum of six weeks physiotherapy before considering rotator cuff repair surgery. Surgery may be recommended if pain doesn’t improve with non-surgical treatments or if the patient is very active and relies on strong shoulder function for work or sports. Other indications that surgery may be required include:
- Symptoms have lasted for 6-12 months
- The tear is large (more than 3 cm)
- There is significant loss of function and weakness of the shoulder
- The tear was the result of a recent, acute injury
Repairing a torn rotator cuff the tendon usually involves re-attaching the tendon to the head of the humerus. There are different method for doing these, each with advantages and disadvantages. The principal goal in every approach is to encourage the tendon to heal.
The type of procedure recommended will depend on the surgeon’s experience, the size of the tear, individual anatomy, any other shoulder problems (such as bone spur for example), and the quality of the bone and tendon tissue.
There are three techniques that are most commonly used to repair rotator cuff tears, including open, arthroscopic, and mini-open.
In-depth research by Seida and colleagues has found no significant difference between open, arthroscopic, and mini-open types of surgery in terms of how well they restore shoulder function 1. Nevertheless, patients often recover faster from arthroscopic surgery because it is less invasive. Some other key findings of Seida and colleagues included:
- Some mini-open repair surgery patients were able to return to work and playing sports a month faster than those that had open surgery.
- Some open repair surgery patients had better shoulder function compared with those who had arthroscopic debridement without repairing the tear.
- There were no differences in the results between patients that had arthroscopic surgery with or without acromioplasty.
There can be some complications associated with rotator cuff repair surgery. In addition to the general risks associated with surgery, some patients may experience nerve injury, permanent stiffness, loss of motion, infections, deltoid detachment, and tendon re-tears. However, most of these risks can be minimised by following appropriate rehabilitation management techniques.
Prevention and Recovery
Everyday wear and tear will promote changes in and around the shoulder joint and these alterations are difficult to prevent. However, is possible to minimise the risk of rotator cuff injuries:
- Perform daily exercises that support strength and flexibility of the shoulder.
- Maintain good posture and avoid lifting heavy objects.
- If actively participating in contact sports, it’s recommended to undertake pre-season screening by an experienced physiotherapist to assess sport-specific technique, flexibility, core-stability, rotator cuff control, and general strength. This can help to identify any risk areas and apply appropriate management.
- Avoid activities that involve elevating arms above the head or out to the side for extended time periods, such as painting ceilings for example. If these activities must be performed, it’s important to take frequent breaks and ice the shoulder accordingly.
Recovery times following rotator cuff injuries can be variable depending on the extent of the injury. Usually rehabilitation will take approximately six months to regain shoulder strength, function and motion. However, rarely is it possible to regain the same range of abilities present pre-injury.
Usually physical therapy for shoulder rehabilitation will occur over three distinct phases:
While complete recovery will take several months, most people have adequate strength and a good function range of motion four to six weeks after surgery.
This video shows ten easy exercises to help strengthen the rotator cuff and support a strong shoulder.
Nutrients supporting rotator cuff recovery
With any shoulder injury it’s important to rest and give the body time to heal. In addition to following the advice of a physiotherapist and/or doctor, paying close attention to diet can also help to support recovery.
Certain nutrients will assist the body to heal faster and help to strengthen the muscles and tendons. Vitamin C, omega-3 fatty acids, copper, and zinc are particularly important for reducing inflammation and accelerating healing. Antioxidant rich foods, such as fresh fruits and vegetables, will reduce the oxidative stress on the rotator cuff and surrounding structures. This will also help to improve the healing processes.
In addition to eating nutrient rich foods, there are a range of health supplements that can also help. By regularly taking a quality supplement the body will receive a boost of nutrients that assist in supporting the healing processes.
- “Seida J, Schouten J, Mousavi S, Tjosvold L, Vandermeer B, Milne A, Bond K, Hartling L, LeBlanc C, Sheps D. (2010). Comparative Effectiveness of Nonoperative and Operative Treatment for Rotator Cuff Tears. Comparative Effectiveness Review No. 22. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-02-0023.) AHRQ Publication No. 10-EHC050. Rockville, MD: Agency for Healthcare Research and Quality. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.” ↩