Shoulder Pain–Is It My Rotator Cuff?
The rotator cuff is a group of 4 muscles that are responsible for the stability of the shoulder. Unfortunately, rotator cuff injuries are very common, either from repetitive overuse or from trauma to the shoulder. These injuries can occur at any age, but are more prevalent later in life. We often think of athletes or heavy laborers as being the most commonly affected, but older adults can injure the rotator cuff when they fall or strain their shoulder, such as when walking a dog on a leash and the dog lurches. If left untreated, this injury can cause significant pain and severely hamper your ability to use your arm.
So What Exactly Is The Rotator Cuff?
The rotator cuff is made up of 4 muscles and tendons (a tendon connects the muscle to the bone) that connect the upper arm bone (humerus) to the shoulder blade (scapula). The primary function of the rotator cuff is to keep the head of the humerus (the “ball” in the ball and socket joint) centered within the socket, thus providing stability to the shoulder joint. The rotator cuff can become irritated and inflamed due to repetitive arm movements, heavy lifting, or a fall which, if left unattended can result in a rotator cuff tear.
Tears often occur as a result of either trauma or long-term overuse of the shoulder. These are commonly labeled as either acute or chronic.
An acute rotator cuff tear is one that recently occurred, often due to trauma such as a fall or lifting a heavy object.
A chronic rotator cuff tear is much slower to develop and often occurs as a result of repetitive actions with the arms above shoulder height–such as with ball throwing sports or certain occupations (e.g., painters, drywallers). People with chronic rotator cuff injuries often have a history of rotator cuff tendon irritation that causes shoulder pain with movement. This condition is known as Shoulder Impingement Syndrome. Rotator cuff tears can also occur in combination with injuries to the biceps tendon at the shoulder, or with labral tears (the cartilage lining the socket of the shoulder).
What Does A Rotator Cuff Tear Feel Like?
Rotator cuff tears can cause:
Loss of shoulder motion
Pain over the top of the shoulder or down the outside of the arm
The injured arm often feels weak, heavy, and painful. In severe cases, rotator cuff tears can keep you from performing your normal daily tasks. This can include lifting your arm to reach a high shelf, tucking in a shirt or blouse, reaching for a wallet in your rear pants pocket, or fastening a bra.
How Is A Rotator Cuff Tear Diagnosed?
Your Physical Therapist should review your medical history and perform a thorough evaluation which includes specialized tests specifically designed to pinpoint the cause of your shoulder pain. These tests are designed to distinguish between an impingement and a rotator cuff tear. These specific tests may cause you to experience some temporary discomfort, but don’t worry–that’s perfectly normal and all part of determining the exact source of your problem. In some cases, your Physical Therapist may feel that a referral to an orthopedic specialist is indicated or for imaging tests such as an MRI.
How Can A Physical Therapist Help Treat A Rotator Cuff Tear?
Once a rotator cuff injury has been diagnosed, your Physical Therapist will work with you to restore your range of motion and strength, while alleviating your discomfort to allow you to return to your normal, daily activities as soon as possible. In the instance where you are a surgical candidate, Physical Therapy can be beneficial pre- and post-surgery to help speed healing and avoid permanent damage.
If You Do End Up Having A Rotator Cuff Repair …
Physical Therapy is a crucial part of the recovery process. The rotator cuff repair site is vulnerable to reinjury following shoulder surgery, so it’s important to work with a qualified Physical Therapist to safely regain full use of your injured arm. After the surgical repair, you will need to wear a sling to keep your repair site protected for anywhere from 2 to 6 weeks. The length of time in the sling is determined by the size of the repaired rotator cuff tear.
Your Physical Therapist will design an individualized treatment program based on both the findings from the evaluation and your personal goals and will guide you through your post-surgical rehabilitation. This progression will take you from gentle range-of-motion and strengthening exercises and ultimately to activity-related or sport-specific exercises. The general timeline for your recovery will vary depending on the surgical procedure and your general state of health, but 4 months is a good ballpark figure to begin activities for a full return to sports, heavy lifting, and other strenuous activities. Your shoulder will be very susceptible to reinjury, so it is extremely critical to follow the post-operative instructions provided by your surgeon and Physical Therapist.
Your rehabilitation will typically be divided into 4 phases:
Phase I (Maximal Protection)–This is where your shoulder is at greatest risk for reinjury and lasts for the first few weeks after surgery. You most likely will need assistance or need strategies to accomplish daily tasks such as bathing and dressing. Your Physical Therapist should instruct you in gentle range-of-motion and isometric strengthening exercises and should provide you with manual therapy techniques such as gentle massage to reduce pain and improve flexibility.
Phase II (Moderate Protection)–The goal of this phase is to restore shoulder mobility. You will gradually wean yourself off of the sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the muscles of your shoulder blade (scapula) as well as core strengthening, muscles that provide additional support and stability to your shoulder. You will now begin to use your arm for non-resisted daily activities, still refraining from any heavy lifting with your arm. Manual Therapy remains a vital part of treatment during this phase.
Phase III (Return to Activity)–The goal here is to restore your strength and joint awareness (proprioception) to equal that of your other shoulder. At this point, you should have full use of your shoulder for daily activities, but you will still be restricted from participating in activities such as sports, yard work, or physically strenuous work-related tasks. Your strengthening program will be advanced by adding more resistance and/or by having you perform more challenging movement patterns. A modified weight-lifting gym-based program may also be initiated at this time.
Phase IV (Return to Sport/Occupation)–You will now be free to focus on return to sports, work, or other higher-level functions. For certain athletes, this will now include throwing and catching drills. For others, it may include lifting heavier objects onto shelves, or instructions in raking, shoveling, vacuuming, or other various forms of housework.
Can A Rotator Cuff Tear Be Prevented?
A trained Physical Therapist can help you to decrease your risk of developing or worsening a rotator cuff tear, especially if you seek assistance at the first sign of shoulder pain/discomfort. To avoid developing or progressing to a rotator cuff tear from an existing shoulder impingement, it is imperative to avoid future exacerbations. Your Physical Therapist can help retrain your rotator cuff muscles in terms of flexibility and strengthening, educate you in terms of potentially harmful shoulder positions, and determine when it is appropriate for you to return to your normal activities.
Practice good posture. A forward head/rounded shoulders position has been shown to alter shoulder blade (scapular) position and create Shoulder Impingement Syndrome.
Add rotator cuff and scapular strengthening exercises into your normal exercise routine. To avoid potential debility of the rotator cuff, general strengthening and fitness programs may improve shoulder health.
Avoid repetitive overhead arm positions that may cause shoulder pain. If your occupation or sport requires such movements, seek out the advice of a qualified Physical Therapist to be instructed in arm positions that may be used with less risk.
Avoid sleeping on your side with your arm stretched out overhead, as well as lying on your involved shoulder. These positions can initiate the process that causes rotator cuff damage.
Avoid carrying heavy objects at your side as this can strain the rotator cuff.
Avoid smoking, as this has been shown to decrease blood flow to the rotator cuff.
Consult a qualified Physical Therapist at the first sign of symptoms.
If you or a loved one is experiencing any of the signs and symptoms of a rotator cuff tear, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30-minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!