The rotator cuff. You use it for everything from waving at someone to reaching into the cabinet for cookie making supplies to throwing a ball to your child. By design, the rotator cuff is a network of four muscles that come together as tendons around the shoulder joint. It helps lift and rotate the arm. This muscle that makes up the shoulder is extremely flexible, constantly in use and, as a result, is also extremely susceptible to injuries.
Those injuries can happen to anyone, from an over-zealous golfer to an overworked painter.
HOW DO I KNOW IF I HAVE A TEAR?
When the rotator cuff is torn – often the tear starts out as a fraying of the muscles – it feels like a dull ache in the shoulder. You may feel a sharp pain when you lift your arms, and it doesn’t seem to get better over time.
The pain usually worsens with use, which is why those professional athletes are often lectured by physicians to never continuing to play through the pain. The same advice goes for all of us.
The tear can be caused by a single injury – like falling off a ladder and landing on your shoulder – or because of overuse, like when a tennis player hits one too many tennis balls.
Permanent stiffness or weakness in the area can arise if left untreated, and the shoulder joint may degenerate.
That degeneration may lead to a complete tear, which requires surgery, three to four weeks of immobilization and extensive physical therapy to strengthen the area and return to normal function.
A rotator cuff tear will show up in an ultrasound or MRI, but not in an X-ray, although an X-ray may show other potential causes of the pain, including arthritis.
NO SURGERY REQUIRED
If you’re fortunate enough to have a small or partial tear and not a complete tear in the rotator cuff, surgery can most likely be avoided.
Upon your first visit to the physical therapist, he or she will likely have you raise your arm, move it out to the side or raise it and ask you to resist a force to determine if you have a tear in your rotator cuff.
The first step after a rotator cuff tear diagnosis is to rest – the dreaded word for many athletes and busy adults.
While resting, avoid overhead arm positions, practice good posture and stopping yourself from sleeping on the side of the painful shoulder. Avoid carrying heavy objects and ice the shoulder to help decrease any irritation and swelling.
After taking some time off, you and your physical therapist will work together to formulate a plan that most often involves exercises that can help restore flexibility and strength to your shoulder.
SURGERY? MORE TIME REQUIRED
Your shoulder may need a longer break if undergoing surgery, which is recommended when a complete tear develops.
Surgery involves putting the torn part of the muscle back together, and you may find yourself in a sling for a while post-surgery.
Soon after surgery, a physical therapist will get you started on a combination of exercises that will ultimately reduce the pain, reduce joint and soft tissue swelling, inflammation and restriction, improve joint mobility, strengthen muscles and reduce the risk of another tear happening.
PHYSICAL THERAPY EXERCISES
The American Academy of Orthopaedic Surgeons advises a four-to-six-week conditioning program that targets the muscle groups around the shoulders and works on strength and flexibility.
THINK YOU HAVE A TEAR?
Think you have a rotator cuff tear? Maybe you’re feeling the dull ache as described above in your shoulder? Find a Tidewater Physical Therapy clinic near you and make your own appointment. The physical therapists in Richmond, Newport News, Hampton, Gloucester, West Point, Williamsburg, Virginia Beach, Norfolk, Chesapeake, Smithfield, Franklin and beyond, are Direct Access certified and can see patients without a referral from a physician. Learn more about Direct Access here.
- “Typical” Rotator Cuff Impingement Syndrome: It’s not Always Typical – George J. Davies, PT, Med, ATC, SCS, CSCS, and Chris Durall, PT, MS, AT, CSCS
- Rotator Cuff and Shoulder Conditioning Program – American Academy of Orthopaedic Surgeons
- Mayo Clinic Rotator Cuff Injury Overview