Rotator Cuff Strain Physiotherapy

Physiotherapy treatment for Rotator Cuff Strains and Tears

The shoulder joint is a ball and socket joint. It is formed from a ball on the top of your arm bone (the humerus) and a shallow socket. Above the shoulder joint is a ligament that is attached to a bony prominence (acromion). This forms an arch. The area between the top of the humerus and the arch is known as the sub-acromial space.

When you move your shoulder you control the position of the joint by using a group of muscles and tendons known as the Rotator Cuff. The Rotator Cuff is very important in stabilising the shoulder joint. The four muscles of the rotator cuff attach from the shoulder blade (scapula) onto the humerus. They blend together to form a cuff passing through the sub-acromial space. One tendon in particular - the supraspinatus sits in the middle of the sub-acromial space. A small fluid lining (bursa) cushions the tendon from the roof of the arch.

The Rotator Cuff is vulnerable to tendon damage or degeneration, particularly affecting the supraspinatus tendon. As you get older the muscles and tendons degenerate and become thinner. The tendons are also worn down by the acromion bone which rubs on the Rotator Cuff. With years of repeated rubbing the muscle and its tendon can eventually lead to problems ranging from mild inflammation to full thickness tears. Sometimes there is a precipitating event e.g. overuse of the shoulder such as tennis, DIY, hedge trimming or carrying luggage.

The Rotator Cuff can be strained completely torn or partially torn from a single traumatic injury, such as a fall or a football tackle. Patients can often report shoulder pain for several months prior to a specific injury that triggered the onset of the pain. A Rotator Cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation. Commonly, Rotator Cuff tears develop gradually as a result of wear and tear on the tendon. This is partly age related, but may result from longstanding impingement. Rotator cuff tears are most common in people who are over the age of 40. Younger people tend to have rotator cuff tears following acute trauma or repetitive overhead work or sports activity.

What are the Symptoms?

Symptoms vary between individuals and depend on the size and the extent of the Rotator Cuff damage. In general, the larger the strain or tear, the worse the arm function is. A completely torn Rotator Cuff, or full thickness tear can never heal but the painful symptoms and shoulder function can be controlled and improved.

Helpful Investigations may include X-ray, Ultrasound or MRI scan. However this not always necessary. X-rays of a shoulder with a Rotator Cuff strain or tear are usually normal or show a small spur. An ultrasound or MRI can show the soft tissue structures such as the rotator cuff tendon better. A scan can sometimes tell how large the tear is, as well as its location within the tendon itself or where the tendon attaches to bone.

Physiotherapy

Physiotherapy is very important. A strain and many partial tears can be completely curable with correct non operative treatment. They are treated conservatively with physiotherapy much the same way as we treat impingement but with more focus on strengthening the rotator cuff and restoring good muscle patterns around the shoulder.

During your initial consultation, a complete assessment of your shoulder will be undertaken to accurately diagnose the problem, and from this an individual treatment programme will be designed. This may include exercises to strengthen your Rotator Cuff muscles, postural exercises, and stretches for your shoulder. Other treatments may include activity modification, manual therapy to relieve the inflammation, mobilisations to try to increase the sub-acromial space, electrotherapy, taping and ergonomic assessment.

Other options

Unfortunately, if the damage to the Rotator Cuff is severe it may not respond to conservative treatment and may require more invasive treatment. Injections can be helpful as the cortisone injection acts on both acute and chronic phases of inflammation to reduce both tissue swelling and subsequent scar formation. Cortisone injections make up a very important part of the treatment of shoulder injuries in combination with an active rehabilitation program they may significantly reduced the need for surgery in Rotator Cuff tears.

In some cases if your symptoms do not settle an operation may be suggested. Complete tears often need to be repaired surgically. There are several different techniques available to repair the Rotator Cuff. The aim of the operation is to repair the torn tendon to the part of the bone from which it has become detached. Depending on many factors a surgeon will decide between an open repair and an arthroscopic procedure. Arthroscopic procedures have good results if the tear is quite small and the rehabilitation may be quicker than with an open repair. A Rotator Cuff repair is a big operation which has a long rehabilitation time.

If you have had a surgical repair then you will require physiotherapy after your surgery. Each surgeon has their own post operative exercise protocol and your physiotherapist will follow this when they advise you on your exercises and monitor your progress. Post operative rehabilitation usually takes 3-6 months to complete.