How to Survive a Rotator Cuff Tear
While thinking up the title for this article, I actually laughed out loud. Given the diversity of sources available to learn about rotator cuff injuries and boatload of corresponding data, surviving the information tsunami is more like it. Yet, knowledge is power, and here we are talking about it once more. Hopefully my colleagues will read this article and share in my humor without questioning the blatant hyperbole.
Okay, time to get serious. The rotator cuff is a group of four independent muscles that function to dynamically stabilize the glenohumeral (shoulder) joint. The muscles bind to a cuff-like covering of the humerus (upper arm) bone to provide the shoulder joint with control and strength in both rotational and directional movements. Specifically, their main functions are:
- Supraspinatus Muscle – Lift the arm out to the side (abduction) and slightly forward
- Infraspinatus Muscle – Rotate the shoulder externally
- Teres Minor Muscle – Rotate the shoulder externally
- Subscapularis Muscle – Rotate the shoulder internally
Rotator cuff symptoms vary based on the degree and exact location of the injury. The most common rotator cuff injury is a strain or tear in the supraspinatus. Specifically, active individuals who perform a large amount of overhead throwing and lifting activities place excess strain and trauma on rotator cuff tissue. In addition, external rotation (the weakest shoulder motion) contributes to the prevalence of impingement mechanisms upon the rotator cuff.
Rotator cuff injuries are grouped into two categories:
1. Tendinopathy – Inflammation or degeneration of a tendon
2. Tear or Strain – Disruption of a tendon and/or muscle
Signs and Symptoms of a Rotator Cuff Injury
- Discomfort that can range from an ache to sharp, localized pain
- Front shoulder tenderness that is more palpable when reaching behind the back, alongside general lateral deltoid pain with no associated tenderness in that area of the shoulder
- Increased symptoms when raising and lowering the arm, especially when using a horizontal or shoulder-level range of motion
- Noticeable weakness in most shoulder movements, especially when lifting the arm overhead and with resisted external rotation
Acute Rotator Cuff Tear Symptoms:
*Common causes of injury are suddenly falling on an outstretched arm or experiencing a rapid impact to the shoulder muscles, such as from the ground or an opposing player.*
- Tearing sensation felt within the shoulder, immediately followed by significant pain throughout the shoulder girdle
- Severe pain in a specific location followed by spasms and general shoulder joint stiffness
- Weakness that ranges from minimal to severe enough to impair any active arm abduction (moving away from the side of the body), depending on the degree of tendon/muscle disruption
- Limited active shoulder movement secondary to pain and weakness
Chronic Rotator Cuff Tear Symptoms:
*Chronic rotator cuff injuries develop over a period of time. Due to excess impingement-type friction related to chronic pathology, the tear usually occurs at or near the tendon, typically on the dominant side. Athletes with this condition are generally over the age of 34.*
- Ongoing symptoms with a gradual increase in both pain and weakness, both of which may become severe
- Increased symptoms during rest and while sleeping on the involved side
- Range of motion limitations and weakness that vary based on the location and severity of injury
Treating a Rotator Cuff Injury
- It is important to obtain a detailed history of trauma to the shoulder, neck, chest and upper arm to help outline treatment based on the specific body part and tissue type.
- A thorough bilateral assessment can point to major limiting factors: weakness, range of motion, and/or pain.
- Work to progressively regain range of motion in the shoulder from the onset of the injury.
- Apply ice to address any increase in shoulder joint warmth and soreness. When dealing with a chronic injury, utilize a contrast of warm/cold treatments to help increase blood flow.
- Increasing strength without amplifying symptoms is a top priority when treating any type of a rotator cuff injury. Employ a treatment program where special attention is paid to this balance, increasing the strength of external rotators while applying caution in overhead exercises.
- Soft tissue massage and manual therapy to the shoulder, upper back and neck helps normalize mechanics of the entire shoulder girdle.
- Implement scapula (shoulder blade) exercises early on in the rehab plan. Enhance the strength and endurance of the shoulder stabilizers with activities such as planks, isometric arm holds and upper extremity weight-bearing medicine ball rolls.
- Help improve proximal shoulder strength with distal extremity work such as hand-gripping, wrist curls and triceps extensions.
- Sport-specific activities can be added to the treatment plan when shoulder strength returns to at least 75%, with extra caution given to all throwing and overhead activities.
Ask the Right Questions Like a Pro
Smart professional athletes with a rotator cuff injury who want to safely return to the field or court should ask their sports medicine specialist the following questions:
1. Are my rotator cuff symptoms due to an actual tear, or are they related to a tendinopathy?
2. Is an MRI or MRI Arthrogram needed to properly diagnose my injury?
3. How would you grade the strength in my affected shoulder, compared to the other side?
4. Do you think I will need rotator cuff surgery now or in the future?
5. Which physical therapist(s) do you recommend to rehab my injury?
Sports Medicine Tips for Living With a Rotator Cuff Injury
Get on Your Nerves – Body nerves can be fickle, so be sure your sports medicine specialist thoroughly evaluates your neck, muscles and shoulders to avoid missing any nerve-related reasons for your weakness.
Be a Chatty Cathy – That concussion last month…the pins and needles feeling you get when you sleep on that arm…these things do matter. Tell your doctor anything and everything you know about signals from your body and let him/her figure out what’s not important.
Break Out Your Mental Scale – Don’t let the fact that you have a rotator cuff tear make you believe surgery is inevitable. Weigh your lifestyle factors and corresponding limitations, along with the medical opinions of trusted professionals, before making the decision to go “under the knife.”
Take the Long View – Surgery or not, a rotator cuff injury dictates a long-term treatment plan. This will provide a clear roadmap of stretches and strengthening exercises that you will do along with vulnerable activities/exercises you will not do. Knowing both is important for an active future.