Pain > Left Shoulder Pain > Torn Rotator Cuff Physiotherapy Symptoms
Torn Rotator Cuff Physiotherapy
Symptoms & Treatment
Patients who sustain a torn rotator cuff will experience symptoms such as
- pain across the shoulder
- arm weakness and
- difficulty with activities above or behind your head
Our rotator cuff muscles refer to a group of four specific muscles which
control the movement and position of the shoulder. Any forms of damage to the
rotator cuff tendons can happen
- through repetitive wear and tear or
- from an injury such as a fall on to an outstretched arm
Rotator cuff tears are actually a very very common cause of shoulder pain and are often associated with shoulder impingement syndrome.
Typically, this painful shoulder condition most commonly affect
- people over the age of forty
- sportsmen and
- construction workers
In this torn rotator cuff article, we will look at
- how our rotator cuff muscles works
- how they can get damaged
- what are the common
torn rotator cuff symptoms
- what are the common diagnoses and
- rotator cuff injury treatment options
What is the Rotator Cuff?
The rotator cuff is a group of four muscles that work together to
control and move the shoulder.
Our shoulder is made up of three bones:
- the humerus (arm bone)
- scapula (shoulder blade) and
- the clavicle
The shoulder joint, also known as the glenohumeral joint, is type of ball and socket joint. The round head of the humerus forms the "ball"
which sits in the shallow socket formed by part of the scapula.
rotator cuff muscles surround the joint holding the ball and socket
together like a glove, and they connect the humerus to the shoulder blade.
Each rotator cuff muscle
originates from the shoulder blade and forms into tendons which then inserts (attaches) on to the
Note that it is the rotator cuff tendons part that tends to get damaged.
The four muscles that make up the rotator cuff are:
- Supraspinatus across the top of the shoulder. Initiates abduction
(moving the arm out sideways) and stabilises the shoulder during
movement. It is the most commonly damaged rotator cuff tendon out of the 4 muscles.
- Infraspinatus at the back of the shoulder. Laterally rotates the arm (turns it outwards)
- Teres Minor at the back of the shoulder below infraspinatus. Laterally rotates the arm (turns it outwards)
- Subscapularis that runs across to the front of the shoulder. Medially rotates the arm (turns it inwards)
Causes of Rotator Cuff Tears
Torn rotator cuff symptoms can develop gradually over time through
wear and tear, known as a degenerative tear, or suddenly from an injury,
known as an acute tear.
1) Degenerative Tear
This is the most common cause of rotator cuff tears. As we age, the
rotator cuff increasingly experiences wear and tear from a number of
- Repetitive Friction: repetitive
activities which involve the rotator cuff will increase the strain on the rotator cuff
Activities where the arm is frequently overhead such as sports
with throwing motions or racket sports, occupations involving manual
labour and general day-to-day activities above head-height particularly
increase the strain on the rotator cuff making it prone to damage.
- Bone Spurs: as we
age, we can develop bone spurs, small outgrowths of bone which make our
joints less smooth. These spurs can rub on the tendon, leading to
fraying and gradual shearing and tearing of the tendon
we reach and cross over the age of around
forty years of age, any damage to the tendons tends to become
increasingly slow to heal as the blood flow and circulation isn’t as
good as compared to when we are young.
That's why rotator cuff tears often never get a chance to heal
properly and seem to just get progressively worse.
As a result, you are much more
likely to experience torn rotator cuff symptoms over the age of forty.
posture and poor ergonomics can also make you more prone to a degenerative rotator cuff
One example of this is a forward rounded posture (known as
kyphosis), as it reduces the space in the shoulder joint and that causes and unnatural increase of pressure on the tendons.
2) Acute Injury
Torn rotator cuff symptoms can also develop suddenly after an injury. The two most common ways to damage the rotator cuff are:
- A Fall: landing on an outstretched arm
- Lifting: picking up something awkwardly that is too heavy
patients more of the time develop a rotator cuff tear from an acute injury (falls, trauma, sports injuries) whereas
degenerative rotator cuff tears and more common in those over the age of
Torn Rotator Cuff Symptoms
With a degenerative torn rotator cuff, the symptoms tend to start of fairly
mild and get progressively worse over time.
Conversely, suddenly and traumatic acute rotator cuff tears
more typically cause instant, immediate and intense shoulder pain.
Torn rotator cuff symptoms
1) Pain: across the
shoulder, often described as a dull ache deep inside.
The pain tends to
get worse when
- lifting or rotating your arm such as with activities such as
brushing your hair or
- when lying on that side in bed which often leads
to disturbed sleep.
As the condition gets worse, you may experience
shoulder pain even when you're resting your affected or painful shoulder.
2) Weakness: difficulty lifting or twisting the arm, which can lead to decreased range of movement
3) Crepitus: you may notice unusual cracking or popping noises when you move the arm due to the decreased stability of the shoulder
Torn rotator cuff symptoms will depend on the severity of the injury.
There are three grades for tendon strains:
- Grade 1 Strain: overstretching of tendon, but no fibres are torn
- Grade 2 Strain: a partial rotator cuff tear – some of the fibres are torn
- Grade 3 Strain:
a complete tear, known as a full thickness rotator cuff tear. The
tendon has completely detached from the bone. In this case, you may lose the
ability to abduct your arm (lift it to the side)
Diagnosing Rotator Cuff Tears
Your orthopedic doctor will start by
- taking your history
- finding out how and when
the pain started and
- finding out how the arm is feeling
to identify your diagnosis and if it's a torn rotator
He or she will then continue to examine the arm,
- looking at your range of movement and
- palpating the different structures
- moving your arm into
He may well also examine your neck, as neck
problems often present with shoulder pain.
Depending on your
torn rotator cuff symptoms, your shoulder doctor may send you for further investigations,
- x-rays, to look for any bone spurs or arthritis or
- MRI or
ultrasound scan to look at the soft tissues and identify the presence,
location and size of a tear.
conservative physiotherapy treatment
no injections or surgery
Treatment will depend on
- the severity of the injury,
age of the patient and
- activity level of the patient
Treatment should target not "just"
your torn rotator cuff symptoms, but the underlying core cause of the
problem, such as
- any areas of weakness or
- postural issues and problems
cases, conservative treatment (non-surgical) is sufficient, but in more
severe cases such as grade 3 tears, or if symptoms have failed to
settle, patient may need corrective shoulder rotator cuff surgery.
Conservative treatment usually involves a combination of the following:
Your doctor may prescribe to you painkillers and/or anti-inflammatories to
reduce your torn rotator cuff tear symptoms of pain and swelling
It is very important to avoid activities that cause and aggravates your shoulder pain, if not you may risk the rotator
cuff tear to get worse.
With acute tears, you are likely to be given a sling to
wear initially...but at the same time, it is really important to balance rest and immobilization with keeping the arm moving
in a pain-free range, otherwise shoulder joint stiffness and shoulder weakness will set in
senior physiotherapists can work on a shoulder rehabilitation program
with you to help you
regain strength and movement in the shoulder as well as address any
underlying issues such as poor posture from long term weakness and any shoulder joint
tightness which may have caused or contributed to the shoulder tear in the first place.
We may also carry out deep transverse friction massage to help the
tendons heal correctly and/or acupuncture to help relieve pain. See more
below in item 5.
4) Steroid Injections:
In some cases, your doctor may recommend a steroid injection (H&L or K&L injection) to help reduce your torn
rotator cuff symptoms. A mixture of local anaesthetic and
corticosteroid is injected into the shoulder to help
- reduce pain and
- reduce inflammation
Note that every joint can get at most 2-3 of such injections over few years, or in some patients, over their lifetimes.
5) Shoulder Pain Physiotherapy, which will include treatments such as
Unfortunately, there is no such things as a quick fix for torn rotator cuff
symptoms. It can take a few months for your shoulder pain and torn rotator cuff symptoms and pains to settle down, so it
is important to persevere with treatment.
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