In our physiotherapy practice, we often have to deal with painful shoulders. Different conditions can occur at the shoulder, but rotator cuff tears are a very common one. In this blog, we will review the anatomy of the shoulder and further discuss the implication of such a tear.
In people over 60 years old, this condition is often due to the normal degeneration of the tendons that occurs with age. This normal degenerating process can be influenced by human activities (work, sports, hobbies, etc.). Indeed, movements and/or repeated efforts can gradually irritate the tendons of the rotator cuff.
In people under 50, the tear is usually due to trauma such as a fall on the shoulder, overexertion or sudden stretching of tendons. It can then be either a detachment of one or more tendons of the rotator cuff on humeral bone or a tear in the tendons themselves. The tear may be partial or total.
Here’s an anatomy review to help better understand this pathology:
The shoulder stability is ensured by the four muscles of the rotator cuff (the supraspinatus, teres minor, infraspinatus et subscapularis *couleurs correspondantes sur schéma).
These four muscles are named “rotator cuff muscles” because they all converge to a common fastener on the humerus and all have a function of rotational movement in addition to their function of stability.
The signs and symptoms of a rotator cuff complete tear are often pain in the shoulder stump and an inability to raise the arm to the side (abduction). In incomplete tears, there may be a loss of muscle strength depending on the degree. Often pain can be felt along the arm, and sometimes to the wrist.
It is possible to detect probable tears with a physiotherapy assessment. If a tear is suspected, additional tests such as an ultrasound or a MRI can be prescribed to verify the hypothesis and plan appropriate treatment.
Treatment depends on the age of the subject and the degree of tear. If the tear is large, the orthopedic surgeon may suggest cuff repair surgery. Physiotherapy treatments will be important later to help regain muscle strength and ranges of motion .
Operated or not, physiotherapy treatments (massage, mobilization, gradual strengthening program, antalgic modalities such as electrotherapy, ice and heat) are useful to help with recovery.
Acupuncture can also help relieve pain.