The rotator cuff is a group of muscles that act as stabilisers of the shoulder. The rotator cuff is made up of supraspinatus, infraspinatus, teres minor and subscapularis. These muscles originate on the scapula and connect to the head of the humerus, creating a cuff around the glenohumeral joint. These muscles are active throughout all movements of the shoulder and are essential for proper upper limb function.
Rotator cuff tears are a common injury of the shoulder that can occur at any age, however they tend to be more common in the older population due to degeneration from use over time. In the younger population, rotator cuff tears are usually secondary to an incident or occur in those who are subjected to repetitive overhead activities, for example a bowler in cricket or a manual labourer.
There are a number of ways to classify rotator cuff tears depending on the size, location and shape of the tear. More commonly, the tears are referred to as partial or full thickness tears.
Rotator cuff tears are often asymptomatic. A number of people will have full function and no pain but will show a tear on a scan. A study conducted in 2019 looked at the prevalence of rotator cuff tears in a population who reported no or minimal shoulder pain or dysfunction. It found that 60% of the population had a shoulder pathology and of that 30% had full thickness tears. Furthermore, it found that partial rotator cuff tears had little or no impact on shoulder pain. This study shows that a tear in the rotator cuff does not always cause dysfunction and pain, but of course this is not always the case.
Often a rotator cuff tear, whether symptomatic or not, can be managed conservatively with physiotherapy, however sometimes it may require surgery.
Conservatively Managed Rotator Cuff Tears
There has been shown to be a great deal of success with conservative management of rotator cuff tears through physiotherapy guided rehabilitation. The body is amazing at healing and adapting.
Conservative management is often undertaken for:
· Partial and full thickness tears
· Low physically demanding jobs
· People who do not participate in sport which requires high levels of shoulder function
· Pre-operative strengthening
It can be a good idea to do conservative management of a rotator cuff tear before going for surgery because there is the chance of avoiding surgery all together, and research has shown that strengthening before surgery leads to quicker recovery post-operatively.
Conservative management will involve a physiotherapy assessment to determine which muscles are weak in the individual, assess movement biomechanics, and determine personal lifestyle and goals. From the assessment, the physiotherapist will come up with a customised management and exercise program to help restore your function and reduce your pain.
Surgically Managed Rotator Cuff Tears
Surgical repair of rotator cuff tears are done by an orthopaedic surgeon after being referred by a physiotherapist or a general practitioner.
Surgical intervention is often undertaken for:
· Failed conservative management
· Physically demanding jobs
· People who participate in sports requiring high levels of shoulder function
· Loss of function
· High pain levels
· Acute injury in the younger population
After surgery, the patient is typically required to stay in a sling for 6-8 weeks (this can vary depending on the surgeon and the type of repair). During this time the patient will see a physiotherapist for targeted exercises. Physiotherapy guided rehabilitation is continued after removal of the sling for strengthening and rehabilitation of the shoulder for a number of months.
A 2016 meta-analysis concluded that there was no significant difference between surgery and active physiotherapy rehabilitation at one year for function and pain for symptomatic rotator cuff tears. Surgery is expensive and has a higher risk of complications, thus conservative management guided by a physiotherapist is advocated as the initial management of rotator cuff tears.
If you are experiencing shoulder pain or have been told you have a rotator cuff tear in your shoulder, it is important to consult a physiotherapist so that they can assist you in your rehabilitation and get you back to your full function.
