Rotator cuff tears

The shoulder joint also known as the glenohumeral joint is highly mobile. This allows for the greatest range of possible places your functional hand can access. It achieves this level of mobility by working with other associated joints in the area: the acromioclavicular and sternoclavicular (which are located at either end of your collarbone), and scapulothoracic joint (which describes the movement of your shoulder blade over your ribcage). These joints play a role in connecting your arm bones to your central skeleton and work together to allow more movement than one single joint could alone. However, this level of mobility results in the shoulder being an inherently unstable structure.

What keeps the shoulder stable?

The human body has two distinct methods in how it creates stability around a moving joint. One is through passive tissue restraints such as ligaments, the joint capsule, and fascia. These passive tissue restraints have a set limit to which they will stretch and forces to extend beyond this point will result in tissue tearing. Active tissue restraints are the second method used to provide stability for a joint. These are the muscles and related tendons that connect the muscle to a body segment. It is through the higher contribution of active tissue restraints that the shoulder joint can be mobile and still stable enough to function.

The four muscle and tendon units that have the greatest role in shoulder stability perform the movement of rotation at the shoulder joint. These units also provide a compressive force to pull the ball section of the upper arm (humerus) into the socket. As a result, this group of muscles are often called the rotator cuff.

Why do rotator cuff tears occur?

Unfortunately the human body was not designed to perform the modern-day tasks we ask of it for the duration of time we often live for. This is obvious of the shoulder joint where the prevalence of rotator cuff issues starts to increase for people in their 4th decade of life. Studies suggest that at least 30-40% of individuals in their 80’s will have full-thickness tears of at least one tendon. Interestingly, although tears can often be found when looking at these tendons through ultrasound and MRI investigation, even full-thickness tears are more likely to be asymptomatic in nature.

A tear is almost always found in the tendon portion of the tissue and can range from small to large. Often, the size of the tear did not correlate with the degree of pain symptoms, although larger full-thickness tears are more likely to cause weakness. Along with weakness, the most common symptoms reported by those who were confirmed to have a rotator cuff tear included: pain, reduced flexibility, pain at night lying on the shoulder, crepitus (cracking/creaking sounds with movement).

Treatment for rotator cuff tears

Treatment for rotator cuff tears can vary in nature depending on the presentation. For individuals who are coping quite well with their rotator cuff tear, they are often advised to maintain strength and good habits around the shoulder area. For others, they need certain treatment modalities and targeted strengthening and rehab to build some balance back in the muscles around the shoulder blade and shoulder joint. In some cases, an anti-inflammatory injection can assist in getting them back on track to build strength and function. There are also situations where surgical intervention is the best option to help repair a damaged tendon and regain better function. A thorough assessment and discussion regarding your symptoms and how you are managing will help your physiotherapist and medical team advise what the best options are in your situation.

We at Malvern Physio are always happy to discuss your injuries and concerns in detail. If you are keen for more specific information about your shoulder and its function, please contact our friendly reception team to arrange an appointment or book online.

Written by Mark Fotheringham, principal physiotherapist at Malvern Physiotherapy Clinic

 

Published July 27, 2020