Rotator Cuff Tears - All you need to know

The rotator cuff is made up of 4 muscles that attach from the shoulder blade (scapula) to the arm bone (humerus). These four muscles have an important role in keeping your ball and socket shoulder joint securely in place. They allow you to lift and rotate your arm smoothly. These muscles are the supraspinatus, which sits on the top of the shoulder blase, the subscapularis which sits on the front of the shoulder blade, and the infraspinatus and teres minor on the back.

Rotator cuff tears are a common source of shoulder pain and dysfunction, especially in those who perform repetitive overhead activities or in the older population. When one or more of these is torn, it can lead to pain, weakness, and limited mobility in the shoulder.

Illustration depicting the anatomy of the shoulder, highlighting a full thickness tear in the supraspinatus tendon of the rotator cuff.

Causes and Symptoms

Rotator cuff tears can occur either due to a sudden trauma, such as a fall, lifting something heavy, or a direct blow to the shoulder or they can develop gradually over time due to degenerative wear and tear. Common symptoms include:

• Persistent shoulder pain, especially when lifting the arm

• Weakness in the shoulder

• Difficulty sleeping on the affected side

• Clicking, snapping or popping sounds with movement

• Limited range of motion

A tear can be partial, where the tendon is damaged but not completely severed, or full-thickness, where the tendon is completely torn away from the bone.

Who is at risk?

Age – the risk increases with age as rotator cuff tears are most common in people over 60.

Some occupations - jobs that require repetitive overhead arm motions, such as carpentry or painting, can increase the risk of damage to the rotator cuff over time.

Certain sports - more common in people who participate in sports like baseball, tennis and weight-lifting.

Family history - there may be a genetic link as they appear to occur more commonly in certain families.

Diagnosis

Diagnosis will usually involve a clinical examination gathering information about pain levels, mechanism of injury and functional limitations followed by an assessment of range of motion, strength, shoulder tenderness and specific rotator cuff tests. If a rotator cuff tear is suspected then Imaging tests, such as X-rays, ultrasound, and MRI, are then used to visualise the rotator cuff tendons and identify any tears.  

Do I need to have surgery?

Some research studies have shown as much as 10% of people in their sixties, 20% of people in their seventies, and 40% of people in their eighties have a rotator cuff tear on ultrasound and have no shoulder pain or dysfunction so the presence of a tear in itself is not a justified reason to have surgery, as there are many people living full and normal lives with these tears.

Whether or not you need to have surgery will depend on factors such as your symptoms, overall health, and the type of tear you have so a surgeon will be able to discuss this with you. Non-surgical treatment is often the first line of management for partial tears and some full-thickness tears. This is where physiotherapy plays an important role.

The Role of Physiotherapy

Physiotherapy is essential in both the conservative management and post-operative rehabilitation of rotator cuff tears. A tailored physiotherapy program can reduce pain, restore function, and improve quality of life without the need for surgery. These treatments include:

1.        Pain Management: manual therapy, ice or heat application can help reduce pain and inflammation.

2.        Range of Motion Exercises: gentle stretching exercises help restore flexibility in the shoulder joint and prevent stiffness.

3.        Strengthening Exercises: strengthening the remaining intact rotator cuff muscles and surrounding stabilisers like the deltoid and scapular muscles are crucial for rehab.

4.        Postural Training: Poor posture can worsen symptoms, so it is important to correct muscle imbalances and follow ergonomic advice.

5.        Functional Training: Gradual reintroduction to daily and sport-specific activities ensures a safe and effective return to work or sport.

There are some instances in which surgery will be necessary, but again physiotherapy plays a vital role as post-operative rehab follows a structured protocol that progresses from passive movement to active strengthening over several weeks or months.

Conclusion

Rotator cuff tears can be debilitating but surgery is not necessary for all tears as research has shown that as much as 80-85% of patients improve with non-surgical treatment with most patients achieving good functional outcomes, but it can take up to one year. Physiotherapy plays an important role in both non-surgical and post-surgical recovery. If you’re experiencing shoulder pain, consulting a physiotherapist early can help prevent further damage and speed up your return to pain-free activity.

Return to work and sport testing

Here at our clinic, we have access to state-of-the-art technology that is used worldwide to measure an individual’s precise shoulder strength, power, movement, asymmetry and more. These can help empower the client as well as help our physios make more accurate data-informed decisions regarding return to sport or work.

By

Cathal O’Kane

Senior Physiotherapist