Rotator Cuff Injury: What is my rotator cuff and how to treat it?

Holly Lipson

July 28, 2021

Introduction

Injury to the rotator cuff is a common presentation seen in the clinic.  Cuff tears can be traumatic in nature via a large push or pull force to the shoulder, or more commonly can be atraumatic in the more degenerative cuff due to repeat mictro trauma over time.  The later are more commonly seen in clinic and will be the focus of this blog.

What is the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that create a ‘cuff’ around this joint and centralise the humeral head in the socket. The bony anatomy can be compared to e golf ball on a tee and thus is not overly stable on a stand alone basis.  This is why the labrum and the rotator cuff play extremely important roles in ensuring the humeral head remains centred in the glenoid and thus, the shoulder remains stable.  The rotator cuff muscles can be viewed below.

(SSOR, 2021)

How can injury occur?

Atraumatic degenerative cuff injury is common in the community with a prevalence of up to 21% and this figure increases with age (Yamamoto et al., 2010). Hand dominance and a history of trauma are also risk factors for cuff injury (Yamamoto et al., 2011).  Atraumatic Injury may from repetitive micro trauma over time (such as that seen in overhead athletes) or from excessive joint instability causing the humeral head to abut the relevant cuff tendon and cause tendon change and injury.

Assessment of rotator cuff injury in clinic

Typically, the patient seen with a degenerative cuff injury will be aged 40 or older and experiencing pain which is worse with activities such as lifting, carrying or reaching (supraspinatus and infraspinatus) or pushing type activities (subscapularis).  There may be a gradual onset of symptom worsening following an increase in shoulder activity or the pain may be insidious in onset. Classically (but not always) the patient will report pain to the antero-lateral shoulder as well as the presence of night pain.

At Grand Slam Physiotherapy, along with regular clinical tests, we also use shoulder symptom modification tests to help better determine which rehabilitation approach works best for our patients.  This approach is supported within the literature (Pizzari et al., 2014). 

When is conservative treatment recommended?

Generally speaking, if the cuff tear is small to medium in size, a conservative approach to treatment is recommended. Furthermore, it may be with larger sized tears that are degenerative in nature, the quality of the cuff tissue is poor, making a repair success less likely. This would of course be a conversation that the patient would need to have with their specialist shoulder orthopaedic surgeon.

What about surgery?

On average, 37.4% of full thickness rotator cuff tears are likely to progress over time (42 months) and so it is advised that these cases seek an orthopaedic opinion to whether or not they are suitable for surgery (Kwong et al., 2019).  As mentioned previously, sometimes it is a matter of whether or not there is enough quality tendon available which determines if a repair is possible or not. Again, this is a decision left to the orthopaedic specialist.

What can you expect with Rehabilitation?

At Grand Slam Physio we utilise symptom modification techniques in our assessment to best guide which rehabilitation pathway will best suit the patient. Not each patient will present the same and therefore every patient will require individualised rehabilitation to ensure they get the best care possible.

About the Author

Holly is about to complete her Sports & Exercise Physiotherapy Masters and has a special interest in treating shoulder injuries. Call 52772151 or book online to make an appointment.

References

Kwong, Cory A, Ono, Yohei, Carroll, Michael J, Fruson, Lee W, More, Kristie D, Thornton, Gail M, and Lo, Ian K.Y. “Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review.” Arthroscopy 35.1 (2019): 228-34. 

Pizzari T, Wickham J, Balster S, Ganderton C, Watson L. (2014).   Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula. Clin Biomech.;29(2):201e205.

Sonnabend DH, Howlett CR, Young AA (2010).  Histological evaluation of repair of the rotator cuff in a primate model. J Bone Joint Surg Br. 92(4):586e594.

SSOR (2021).  Rotator Cuff (Image), Accessed from https://ssorkc.com/torn-rotator-cuff-fix.

Yamamoto, Atsushi, MD, Takagishi, Kenji, MD, PhD, Osawa, Toshihisa, MD, PhD, Yanagawa, Takashi, MD, PhD, Nakajima, Daisuke, MD, Shitara, Hitoshi, MD, & Kobayashi, Tsutomu, MD, PhD. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery19(1), 116–120.

Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T (2011). Factors involved in the presence of symptoms associated with rotator cuff tears: A comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg. 20(7):1133e1137.