Rotator Cuff Tear

Symptoms, Causes, Diagnosis & Treatments

By Mahnoush Rodriguez
Last Updated: September 9, 2018

❯ Shoulder Pain

Rotator cuff tear is a common shoulder injury and one of the leading causes of shoulder pain.

In this article, you’ll get an overview of what a rotator cuff tear is, what causes it and its symptoms and how it’s diagnosed and treated.

Important Note

DoctorsConvey does not provide medical advice, diagnosis or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Learn more

CONTENTS


overview-click

Overview


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Causes & Risk Factors​


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Signs & Symptoms


diagnosis_tests​-click

Diagnosis & Tests​


treatment_options​-click

Treatment Options​


home_treatment_remedy​​-click

Home Care & Remedy​


overview-click

Overview


causes_risk_factors​-click

Causes & Risk Factors​


diagnosis_tests​-click

Diagnosis & Tests​


signs_symptoms-click

Signs & Symptoms


treatment_options​-click

Treatment Options​


home_treatment_remedy​​-click

Home Care & Remedy​

You can also download our free ebook to learn more about rotator cuff tears.

Rotator Cuff Tears: Overview

overview-chapter1
What you learn in this chapter:

  • What is a rotator cuff tear?
  • Rotator cuff anatomy
  • Types of rotator cuff tears
    • Partial-thickness tear
    • Full-thickness tear

What Is a Torn Rotator Cuff?

Rotator cuff tears are tears in one or more of the tendons of the rotator cuff muscles.

They can appear following a trauma such as falling on an outstretched arm,
Or
They can be the result of tendon wear and tear due to aging or repetitive overhead movement and lifting.¹

A torn rotator cuff can cause pain and restrict your shoulder movement.

FREE eBook: Rotator Cuff Tear

The more you know about your shoulder condition, the better prepared you are to improve it.

Get the ebook

Rotator Cuff Anatomy

A group of four muscles and their tendons create rotator cuff in your shoulder.

The rotator cuff muscles connect your shoulder blade (scapula) to the top of your upper arm bone (humeral head).

These muscles are essential for stabilizing the shoulder joint and keep the humeral head in the shoulder socket.
With the help of these muscles, you can raise your arm and rotate it in different directions.²

rotator_cuff_muscles_tendons

Rotator cuff muscles and tendons

The muscles of the rotator cuff are located deep in your shoulder.
Each of the rotator cuff muscles has a tendon.

These tendons join together to create the rotator cuff tendon.

  • Supraspinatus
  • Subscapularis
  • Teres minor
  • Infraspinatus
Supraspinatus

The most commonly torn tendon of the shoulder is the supraspinatus tendon.¹

Supraspinatus tendon is somewhat different than normal traction tendons since it also glides over the humeral head.
In 95% of complete rotator cuff tears, supraspinatus tendon is involved.³

rotator cuff supraspinatus tendon

Types of Rotator Cuff Tears

Rotator cuff tears can be classified into two broad groups:

  1. Partial tear
  2. Full-thickness tear

① Rotator cuff partial tear

A partial-thickness tear, also known as an incomplete tear, is fraying of the tendon.

In partial tears, the tendon generally remains intact and functional, but there are lesions present that weaken it.

partial rotator cuff tear
Partial tears are commonly classified based on
1) the location of the tear
and
2) how deep they are as a percentage of the tendon thickness:⁴
• Grade I: less than 3 mm deep (<25% of tendon thickness) 25% • Grade II: between 3–6 mm deep (25–50% of tendon thickness) 50% • Grade III: more than 6 mm deep (>50% of tendon thickness)
90%

② Rotator cuff full-thickness tear

A full-thickness tear can be a small hole in the tendon or a large tear that completely detaches the tendon from the bone – total rupture.
rotator_cuff_full-thickness_tears

  • If there are full-thickness tears in the tendon, but the tendon is still substantially attached to the humeral head, it is possible you preserve normal shoulder function without experiencing any symptoms.⁶
  • If the full-thickness tears have caused the tendon to detach from the humeral head completely, it can restrict your shoulder function.


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Rotator Cuff Tear: Causes & Risk Factors

causes_risk_factors​-chapter2

What you learn in this chapter:

  • What causes a torn rotator cuff?​
    • Types of tears by cause
      • Acute tears
      • Chronic tears
    • Acute on chronic
  • Rotator cuff tear risk factors

What Causes a Rotator Cuff Tear?

The leading causes of rotator cuff tears are acute injuries and chronic repetitive injuries.¹

  • Acute injuries
  • Chronic repetitive injuries

Types of rotator cuff tears

Based on the cause of injury, tears are commonly classified into two major groups:

  1. Acute tears
  2. Chronic tears
① Acute tears

Injury or trauma to the shoulder can lead to acute tears.
These tears typically appear in people with no history of a shoulder problem and make elevating the arm difficult.⁶

Acute tears can happen in an instant when sudden traumatic stress affects the shoulder.
Depending on how healthy and robust your shoulder and its tendons are, the level of force required to do the damage may vary.

  • High stress

If you have a healthy shoulder with no underlying condition, a relatively powerful force is needed to tear your rotator cuff.

For example, it can happen when you forcefully fall on your shoulder while extending your hand to break the fall.

acute rotator cuff tear high stress
acute rotator cuff tear moderate stress

  • Moderate stress

An underlying condition may increase the likelihood of rotator cuff tears when exposed to a relatively moderate or even a low force.

For example, a person with bone spurs in the shoulder can injure his or her rotator cuff with a relatively modest force.

② Chronic tears

Also known as degenerative tears, chronic tears are often the result of progressive degeneration of the tendon.
These tears develop slowly over time.⁶

Multiple factors can cause chronic tears such as:

  • Aging and lack of blood supply

As we age tendons degenerate and wear naturally. When the tendons weaken, they become more prone to injury and tear.

At the same time, for tendons to repair themselves from any damage, they need to receive enough blood supply. However, aging decreases blood circulation in the rotator cuff tendons.

This can impair the timely healing of the damages and can contribute to their accumulation and severity over time.⁷

aging lack blood supply tendons
repetitive_stress_overuse

  • Repetitive stress and overuse

Tears can happen if you perform the same shoulder movement frequently over an extended period of time.

The repeated action, especially if done with improper technique, can damage the shoulder tissues like tendons.

If the body is not given enough time to repair itself and heal, the excessive wear can lead to tears.

People who play sports or do jobs that require repetitive overhead motion and heavy lifting are at higher risk for this type of injury.⁸

  • Shoulder impingement

Shoulder impingement occurs when the space below the acromion where the rotator cuff tendons run through becomes narrow due to reasons like bone spurs.

In that case, when you raise your arm, the rotator cuff gets squeezed which irritates the tendons. Repetitive impingement and wear can damage the tendons over time and lead to tears.⁷

shoulder_impingement_supraspinatus_tendon

EXTRA: What is Shoulder Impingement?

Learn more about shoulder impingement causes, symptoms, diagnosis and treatments.

Acute on chronic

An individual can have chronic tears without any symptoms.
If an acute injury happens in the shoulder, the trauma can aggravate the chronic tears.
This condition is referred to as acute on chronic.⁶

Risk Factors for Torn Rotator Cuff

Risk factors that lead to rotator cuff tears are not known very well.⁹
In general, the below elements are believed to affect the development and progression of the tears:

  • Aging

As part of the aging process, people experience age-related degenerative changes in their rotator cuff.¹⁰

This degeneration increases the likelihood of tear development.

It is particularly true after the age of 50.¹¹

At least 10% of those over the age of 60 in the United States have rotator cuff tears.¹²

aging_degenerative_changes

  • Sports

Repeated microtrauma to the shoulder during overhead throwing motions or in contact sports can make the rotator cuff susceptible to injury.¹⁰

Athletes playing sports that are highly dependent on overhead movements and shoulder activities are at higher risks.

Examples are weightlifting, rowing, tennis, kayaking, baseball (pitcher), football (quarterback), swimming and volleyball.

Weight Lifting
Weight Lifting
Rowing
Rowing
Tennis
Tennis
Kayaking
Kayaking
Baseball
Baseball
Football
Football
Swimming
Swimming
Volleyball
Volleyball
  • Occupation

Those who are engaged in heavy labor¹³ or do a lot of overhead working or lifting like painters and carpenters are at a higher risk.
heavy_labor_risk_factor

  • Smoking

Smoking is believed to correlate with the development of the rotator cuff tears and the tear size.⁹·¹⁴

smoking_risk_factor

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Rotator Cuff Tear: Signs & Symptoms

signs_symptoms-chapter3
What you learn in this chapter:

  • Common torn rotator cuff symptoms
    • Acute tears
    • Chronic tears
  • Common instances of pain
  • Muscle atrophy

Always seek the diagnosis from a medical professional.

Symptoms mentioned below are commonly associated with this condition but can also appear in other shoulder problems. So it is crucial you seek an accurate diagnosis from your doctor or other qualified health care professionals.

Torn Rotator Cuff Symptoms

Rotator cuff tears can have symptoms like pain and weakness or can be without any signs.
If you have rotator cuff tears with no pain, you may be at risk for developing symptoms over time.⁶

If there is any symptom, it is typically in the dominant shoulder.⁶

The size of the tears seems to be associated with the development of symptoms.
Therefore, monitoring tear size progression among those treated non-surgically is essential.¹⁵

Also, the presence of a full-thickness tear in one shoulder increases the likelihood of rotator cuff tear in the other one, despite lack of symptoms or pain.¹⁵

Some of the common symptoms of rotator cuff tears include:

  • Shoulder pain

Pain is the most common symptom for this condition, especially with an overhead movement.¹

However, not everybody with rotator cuff tears experiences pain. In fact, it is estimated that 5% to 40% of people without shoulder pain have full-thickness rotator cuff tears.⁶

shoulder_pain

  • Loss of active range of motion

A limited active range of motion and difficulty in elevating the affected arm are common.¹

Activities such as lifting up your arm forward (flexion ) or raising it away from the side (abduction) can become painful or restricted.

shoulder_flexion_abduction

  • Shoulder weakness

Loss of strength in your shoulder may not come to your attention especially if you have pain.

  • If you have a small full-thickness tear, your shoulder may not show any weakness, but with a larger tear, shoulder weakness is usually present.¹⁵
  • This weakness can restrict your shoulder movement and make many daily activities such as dressing difficult.
  • The limited range of motion and pain may lead to less use of affected arm causing more shoulder weakness.
  • Crepitus

When you move your arm in particular positions, you may hear a grinding, cracking or snapping sound called crepitus.⁷

  • Impingement signs

Common rotator cuff impingement symptoms can be present.¹·⁶

Acute tears

An acute tear and its symptoms occur following a traumatic injury.
You may immediately feel an intense pain that radiates to your arm and experience a snapping sensation and arm weakness.⁷

Chronic tears

Chronic rotator cuff tears can lead to considerable disability and reduced quality of life.⁶

However, the severity of tears does not necessarily mean you will have a higher level of pain.¹⁶

Chronic tears may cause pain even when you rest. The pain can get worse and debilitating at times.

Common Instances of Pain

If the rotator cuff tears cause pain:

  • Reaching upward for overhead activities or forward for lifting may become painful.

overhead_activities_pain
sleep_night_pain

  • You may feel pain at night or if you directly lie on your shoulder.
  • The pain may increase when you bring your arm up on the side against resistance.

bring_arm_up_against_resistance_pain
lean_on_elbow_shoulder_pain

  • The pain may increase when you lean on your elbow in a way that pushes up your shoulder.

Muscle Atrophy

Physical inactivity for an extended period of time may lead to loss of muscle tissue which is called muscle atrophy or muscle wasting.

In apparent atrophy, it looks as if the muscle is gone or has become thinner.

This can happen to individuals with long-standing rotator cuff tears.⁶

muscle_atrophy

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Rotator Cuff Tear: Diagnosis & Tests

diagnosis_tests​-chapter4
What you learn in this chapter:

  • How is rotator cuff tear diagnosed?
    • Medical history
    • Physical examination
  • Additional diagnostic tests
    • Conventional radiography (X-rays)
    • Magnetic Resonance Imaging (MRI)
    • Ultrasound
    • MR Arthrography

How is Rotator Cuff Tear Diagnosed?

To diagnose rotator cuff tears, your doctor asks for your medical history and performs a physical examination.

Further diagnostic tests may be required to confirm the initial diagnosis.

Medical history

Your doctor may ask about when and how the injury happened, the level of your physical activity, your symptoms such as pain and weakness and so forth.

medical_history

Physical examination

During the physical exam, your doctor may:⁷

  • Inspect your shoulder and examine it for tenderness, deformity, and strength.
  • Check your shoulder range of motion and types of movements that cause you pain.
  • Examine your shoulder joint and spine to make sure the pain you are feeling is not the result of another condition such as a pinched nerve in your neck.

shoulder_physical_examination

Additional Diagnostic Tests

In many cases, the medical history and physical exam are not enough to make a diagnosis.
Diagnostic imaging enables your doctor to get additional details about your condition.

There is no consensus in the medical field as to what imaging test is the best for torn rotator cuff diagnosis.
A complete physical examination helps your doctor to decide what imaging technique is right for you.¹¹

Standard imaging tests include:¹¹

  • Conventional radiography (X-rays)
  • Magnetic Resonance Imaging (MRI)
  • Ultrasound
  • MR Arthrography

► X-rays

In this test, your body is exposed to x-ray radiation to take radiographic images.
Dense tissues in your body such as bones block the radiation and appear white in the image.
The less dense tissues such as muscles pass most of the radiation and appear gray.

Rotator cuff tears usually remain undetected in x-ray images.
But x-rays can help your doctor to examine and exclude other possible causes of the shoulder pain.¹¹

For example, your doctor can identify bone abnormalities such as bone spurs. Presence of bone spurs can be a sign of shoulder impingement.

shoulder_x_ray

► MRI

MRI or magnetic resonance imaging combines a powerful magnet and radio waves to create images by a computer.

Instead of x-rays, MRI uses a magnetic field.

An MRI scan provides a high level of detail.
It is mainly used to get visibility into organs and soft tissues such as tendons and joints.

The diagnostic accuracy of MRI for the detection of full-thickness tears is excellent but is more limited for partial tears.¹¹

mri_scan_diagnostic_imaging

MRI can also show the location and size of tears and give an idea of how old or new they are.⁷

► Ultrasound

Ultrasound or sonography is an imaging test that uses high-frequency sound waves instead of radiation.

The procedure can display images in real time revealing tissue movements or blood flow.

It is often used to show internal organs, blood vessels and soft tissues such as tendons, ligaments, and muscles.

ultrasound_sonography_diagnostic_imaging

The diagnostic accuracy of the ultrasound for the detection of complete tears is good and comparable to MRI.
It helps your doctor to detect and measure full-thickness tears.¹¹

► MR Arthrography

Magnetic resonance (MR) arthrography is a two-step imaging technique that uses contrast dyes to highlight the joint for taking images.

1. First step
During the first step called arthrogram, a contrast solution is injected into the joint to increase visibility into its structure.

2. Second step
The second step is to take MRI images of the joint.

mr_arthrography_diagnostic_imaging

MR Arthrography is usually considered when a higher level of sensitivity and specificity is required.¹¹

It can show your doctor partial or small tears (less than 1 cm).¹


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Rotator Cuff Tear: Treatment Options

treatment_options​-chapter5
What you learn in this chapter:

  • Rotator cuff tear treatments
  • Non-surgical treatment of rotator cuff tears
    • Rest and activity modification
    • Pain relief for rotator cuff tear
    • Exercise and physical therapy
  • Rotator cuff surgery
    • Arthroscopic repair
    • Open repair
    • Mini-open repair
  • Rotator cuff surgery recovery

Always seek treatment from a medical professional.

Numerous factors affect the treatment choice. Your doctor will pursue a course of treatment that’s suitable for your individual health needs and risk factors.

Rotator Cuff Tears Treatment Options

Treatment options typically depend on the type of tear. In other words, it matters whether you have developed a partial tear or a full-thickness tear.

If a partial tear has no symptom and pain, treatment may not be necessary for it.⁵
But keep in mind that partial rotator cuff tear is a risk factor for shoulder impingement syndrome.¹

Full-thickness tears usually have symptoms and may even require surgical treatment.¹

There are two main options for treating a torn rotator cuff:

  • Non-surgical treatment
  • Rotator cuff tear surgery

Factors affecting the treatment choice

Some of the deciding factors in the selection of a course of treatment include:⁶

  • Symptoms

Presence of pain and other symptoms, shoulder function and range of motion, …

  • Tear Type

Full-thickness or partial-thickness tear, …

  • Cause of the tear

Acute tear, chronic tear or a combination of both (acute on chronic), …

  • Characteristics of the tear

Tear size, quality, and integrity of rotator cuff tissues, tendons involved, …

  • Age, health, and lifestyle

General health, age and the physical activity requirements of the person – e.g., professional athletes, …

Non-surgical treatment versus surgery

Several studies have compared the outcomes of non-operative therapy to surgery. But their results have been conflicting and inconclusive.
Therefore, no clear consensus exists for the best approach.⁶

Lack of clinical evidence favoring early surgery persuades many doctors to take a conservative approach initially.
If the individual doesn’t respond to the non-surgical treatment, then an operation may be considered.⁷

Is surgery necessary for a torn rotator cuff?

The American Academy of Orthopaedic Surgeons (AAOS) recommends that rotator cuff surgery should not be performed if the individual has no symptoms.¹⁷

Doctors may recommend an early surgery for those with either acute tears or chronic full-thickness tears greater than 1–1.5 cm who are younger than 60 years old.⁶

While rotator cuff surgery is considered an effective treatment, tears at the repair site can still occur.
This happens more among older people with chronic tears caused by degeneration.⁶

FREE eBook: Rotator Cuff Tear

The more you know about your shoulder condition, the better prepared you are to improve it.

Get the ebook

Non-surgical Treatment of Rotator Cuff Tears

Many doctors initially take a non-surgical approach in treating full-thickness rotator cuff tears.⁶

The conservative treatment doesn’t directly heal a rotator cuff tear.
However, in many cases, it can effectively control the pain which is the primary symptom of this condition.¹⁴

The main objectives of non-surgical treatment are to⁶

  • reduce pain
  • restore shoulder function
  • improve daily activity and quality of life
  • minimize tear progression and other adverse outcomes

Rest and activity modification

Your doctor may advise you to rest and avoid activities that increase your pain.

Using a shoulder immobilization sling for a short period of time may be recommended.
It can help you to avoid unwanted arm movements and protect your shoulder from further injury.⁷

rest_activity_modification

Pain management

Inflammation is one of the primary causes of pain in a torn rotator cuff.
Reducing inflammation in the shoulder may ease the pain.¹⁴

► NSAIDs

If you have pain, your doctor may prescribe non-steroidal anti-inflammatory (NSAID) drugs to reduce swelling and control pain.

NSAIDs are a temporary solution for pain management and can reduce pain in the first 3-4 weeks.
A different treatment approach is required to suppress pain and improve shoulder function completely.¹¹

pain_medication

► Shoulder injections

Corticosteroids (cortisone shots), local anesthetic or hyaluronic acid injections may be administered to relieve pain and improve shoulder function.
These shots are often temporarily helpful.

injection

In the short term, NSAIDs and corticosteroid injections produce similar effects.¹¹

Exercise and physical therapy

Shoulder exercises and physical therapy focus on overcoming shoulder deficits and improving its function.
By correcting modifiable physical problems that add to pain and dysfunction, you may be able to manage the condition and avoid surgery.⁶

shoulder_physical_therapy

Rotator cuff tear physical therapy

After enough rest and activity modification, your doctor may recommend physical therapy.
This is to avoid shoulder stiffness and restore its function.

It is important that the pain and inflammation are under control by this time, so you can adequately perform your physical therapy exercises.

The physical therapy program should be customized to fit your individual needs and condition.

1. Stretching and improving range of motion

This program aims to prevent stiffness in your shoulder and gently enhance its range of motion with a passive set of exercises.
The stretching brings back flexibility to your shoulder.⁷

shoulder_stretching

2. Strengthening program

The strengthening program starts when you achieve a full range of motion without feeling pain.
This program is often designed in a way that improves your shoulder strength gradually over time.
For that, you may also be given a set of exercises to do at home.

shoulder_strengthening_exercises

Rotator Cuff Surgery

Shoulder operation is often considered when the conservative treatment fails to deliver results, or the individual is a candidate for early surgery.

Main surgical procedures

There are many different surgical procedures available to treat rotator cuff injuries.

The methods used may vary based on the severity of your condition and your individual needs as well as your surgeon’s practices and preferences.

  • Rotator cuff tendon debridement

This procedure involves trimming loose fragments of tendon and other debris in the shoulder joint. It is generally indicated as a treatment for Grade I and Grade II partial tears – injuries with the depth of less than 50% of tendon thickness.¹¹

  • Rotator cuff tendon repair

This procedure involves reattachment of the torn tendon to the bone (humeral head).

  • Tendon transfer

This procedure may be used for irreparable rotator cuff tears. If the tendon is too damaged and has a massive tear, the surgeon may decide to replace the deficit with a nearby tendon.¹⁹

  • Shoulder replacement

In case of a massive shoulder injury and large rotator cuff tears, shoulder replacement may be required to improve the condition.²⁰

Types of rotator cuff repair surgery

Surgical techniques for rotator cuff repair include:²¹

  1. Arthroscopic rotator cuff repair
  2. Open rotator cuff repair
  3. Mini-Open Rotator Cuff Repair

surgical_techniques

Progress in arthroscopy technology has evolved repair techniques from open repair to mini-open and all-arthroscopic repair.²²

Each technique has its own advantages and disadvantages.

Currently, there is no consensus among shoulder surgeons as to which technique is superior and offers the best outcome.²³

① Arthroscopic rotator cuff repair

Arthroscopy is a minimally invasive procedure for diagnosing and treating joint problems.

In this procedure, a tiny incision is made in the skin around the shoulder to insert a special illuminating instrument called arthroscope.

The arthroscope is a narrow tube with a fiber-optic video camera attached to it.
It allows the surgeon to view the inside of the joint and examine it without the need for a large cut.
To perform the operation, the surgeon makes additional small incisions to insert specially designed pencil-thin surgical instruments.

All-arthroscopic is the least invasive repair method for rotator cuff tears and can be performed as an outpatient procedure.

With the trend towards minimally invasive procedures, arthroscopic treatment of rotator cuff tears has become a routine surgery.²¹

② Open rotator cuff repair

Open surgery is the traditional method of repairing the rotator cuff.
It is often used when the tear is large or complex, or tendon transfer reconstruction is needed.

In this procedure, a 3 to 6 centimeters incision is made over the shoulder.
Then the deltoid muscle is detached from the acromion and split for 3 to 5 cm to perform the repair.²¹

The deltoid reattachment to the acromion is a critical part of the open surgery.
That’s because of the implications it has on the postoperative rehabilitation.²¹

Studies have shown that open rotator cuff repair achieves good to excellent results in 80% to 94% of cases.²¹

③ Mini-open rotator cuff repair

In mini-open repair, the surgeon uses arthroscopy to perform most of the procedure, such as tendon debridement.
This helps to avoid deltoid muscle detachment.²¹

To access the tendon, the surgeon extends the incision made for arthroscopy by 1 to 2 centimeters and split the deltoid to perform the repair.²¹

Studies have shown that 80% to 88% of people undergone mini-open repair achieved good to excellent results at long-term follow-up.²¹

Rotator Cuff Surgery Recovery

A proper post-surgery rehabilitation plan can improve the recovery time and the outcome.

During the recovery period, a gradual mobilization of the shoulder is required to restore motion and flexibility.
Yet, the rehab program should protect the shoulder joint and avoid putting excessive stress on the repaired tendons.¹¹

The timing of the rehabilitation activities is critical too.
Both early and late mobilization can have negative impacts on the shoulder and its recovery.¹¹

Post-surgery rehabilitation and physical therapy

Loss of shoulder function often happens after rotator cuff repair surgery.
A well-designed rehabilitation program and physical therapy is necessary to restore range of motion, strength, and endurance in a timely and safe manner.²¹

shoulder_physical_therapy

Factors affecting the rehabilitation program

The design of the postsurgical rehabilitation program considers many factors such as ²¹

  • Surgical approach

The type of surgery impacts the rehabilitation program.

For example, an open repair in which the deltoid muscle is detached require different program than arthroscopic repair.

  • Size of tear

The size and extent of the tear can indicate how fast and aggressive the program can be.

For example, for small tears (less than 1 cm) the rehab exercises might progress quicker than for larger tears.

  • Tissue quality

The quality of the tendons, muscular tissues and bones are taken into account in the rehab plan.

For example, an individual with good or adequate tissue might undergo a slightly more aggressive program than a person with thin, fatty or weak tissues.

  • Fixation methods

Tendons are attached to the bones in different ways during the surgery.

Each method has its own characteristics such as fixation points and the number of anchors and sutures used.

The rehabilitation program is adjusted to account for these characteristics.

For example, it is believed that double-row fixation is stronger than the single-row technique.

  • Individual factors

Each person has specific characteristics that should be considered in the program.

Age, level of activity, lifestyle habits, work situation, and recreational activities are some of these factors.

For example, the dominant arm of an athlete may require a greater range of motion and strength than the non-dominant arm.

Rehabilitation program goals

The primary goals of postoperative rehabilitation and physical therapy programs are ²¹

  • To protect the repair

The surgery healing process is slow.

You will be educated by your healthcare provider on how to protect the repair site during this period.

Shoulder abduction pillow sling is often used to protect the surgery site.

  • To promote healing

Pressure and tendon immobilization improve the healing process.

  • To gradually restore passive range of motion

Various rehabilitation techniques are used to avoid shoulder stiffness and regain range of motion slowly.

These techniques should ensure the tissue-healing process is not compromised.

  • To gradually strengthen muscles and restore function

Strengthening exercises should be performed carefully to avoid stressing the healing tissues.

If done too early or too aggressively they can lead to retearing of the repair, pain and poor outcomes.


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Rotator Cuff Tear: Home Treatment & Remedies

home_treatment_remedy​​-chapter6

What you learn in this chapter:

  • Importance of self-education
  • Pain management
    • Trigger point therapy
    • Tens therapy
    • Acupuncture for shoulder pain
    • Shoulder heat and ice treatment
    • Massage for shoulder pain
    • OTC topical pain relief
  • Shoulder exercises
  • Nutrition and diet

Always consult with your doctor before trying any home treatments.

Health needs and risk factors are different for everyone. This means not every home treatment and remedy mentioned below is appropriate for you. Ask your doctor or health care provider to see which one is safe and effective for you.

Educate Yourself​

First and foremost, educate yourself about this condition.

If you know the mechanics of your shoulder problem, you would be able to modify your daily habits and activities and have a faster recovery.

Get a couple of books or read reliable websites and educate yourself.

“Reading is to the mind what exercise is to the body.”

Joseph Addison, 17th-century writer and politician

study_health_condition

There are many useful online resources and educational books out there. They often have illustrations and instructions about the prevention, treatment, and control of shoulder conditions.

FREE eBook: Rotator Cuff Tear

The more you know about your shoulder condition, the better prepared you are to improve it.

Get the ebook

These resources help you in two main ways

  • You can ask better questions from your doctor
  • You can explore new ways to restore your health

Take advantage of them and increase your quality of life through knowledge.

Shoulder Pain Management

Below are some examples of things you can do at home to alleviate your shoulder pain.

However, not all the mentioned methods have medical evidence supporting them. So their efficacy and safety are not clear.

Regardless, many people find these methods helpful.

► Trigger point therapy

In trigger point therapy, trigger points are stimulated for pain relief.
The stimulation is done by pressing or rubbing trigger points on the body.

trigger_point_therapy

A trigger point is like a muscle knot that can be the source of pain felt in other parts of the body.

Trigger points, also called myofascial trigger points, are a controversial topic in the medical field.

This can be due to limited understanding of the function of these points.

trigger_point_taut_band_nodule

Regardless of the lack of medical evidence, it seems this method can relieve pain in some people.


EXTRA: Trigger Point Therapy to Ease Pain

Learn more about trigger point therapy and how you can do it at home to relieve pain.

Trigger point tools

You can do this therapy by yourself at home.

Below devices help you to reach and stimulate the trigger points all over your body.
Buy one of them and start the therapy to ease your pain:

trigger_point_self_massage_tool
Self-massage tool
lacrosse_balls
Lacrosse balls
massage_stick
Massage stick
foam_roller
Foam roller

► Tens therapy

TENS stands for transcutaneous electrical nerve stimulation.

In this therapy, a device called TENS unit is used to send electrical pulses to the muscles through the skin.

TENS units stimulate the underlying nerves to alleviate pain.

shoulder_tens_therapy

EXTRA: TENS Therapy by TENS Unit

Learn more about TENS therapy and how you can do it at home for pain relief.

TENS unit

You can get a TENS unit and do this therapy yourself.
Since TENS unit is a small device and is portable, you can also use it at work or on the go.

Buy one of the below best-selling units and relieve your shoulder pain.

tens_7000
TENS 7000 2nd Edition
healthmateforever_YK15AB_tens_unit
HealthmateForever YK15AB
nursal_tens_unit
NURSAL TENS Unit

► Acupuncture for shoulder pain

Acupuncture is a non‐drug therapy for treating shoulder pain. However, its effectiveness or safety is yet to be proven by medical studies.²⁴

In this therapy, the acupuncturist inserts super thin needles into the body to relieve chronic pain.

This method of treatment seems to work by²⁴

  • stimulating the body to release chemicals that ease the pain
  • suppressing pain signals in the nerves
  • allowing energy or blood to better flow in the body

For shoulder pain treatment, the therapist inserts the needles around the shoulder and upper arm.

You can get an appointment and try this ancient therapy to alleviate your pain.

acupuncture_shoulder_pain

► Shoulder heat and ice treatment

Another way to manage your shoulder pain is through heat and ice treatments.
These treatments are common in managing injuries, swelling, stiffness, and pain.

sauna_heat_therapy

Heat and ice affect the blood flow differently:

  • Heat increases the blood flow
  • Ice reduces the blood flow

Ice is typically used to reduce inflammation and pain, while heat can make stiff joints and sore muscles loosen and relax.

Shoulder ice pack and heating pad

Using an ice pack or a heating pad is the simplest way to ease your shoulder pain.

During the treatment, make sure to use a towel as a barrier, so these products don’t touch your skin directly. That’s because extreme heat or cold can damage your shoulder tissues.

Since both ice and heat affect the blood flow, you shouldn’t use them for too long either. Application for an excessive amount of time can result in tissue damages such as frostbite or skin dehydration and burn.

Buy one of the below products to manage your shoulder pain:

shoulder_dual_hot_cold_therapy
Dual Hot Cold Wrap
shoulder_ice_pack
Gel Ice Pack
shoulder_heating_pad
Heating Pad

► Massage for shoulder pain

Everybody likes a good massage!
A well-done massage by a therapist can help relieve tension and pain in your shoulder.

However, always consult with your doctor before doing any massage therapy to make sure it is safe for you and your body can tolerate it without causing any complications.

shoulder_massage_therapy

Massage styles

There are many massage techniques each using a different method to manipulate the body. Below are the two most common ones:

  • Shiatsu massage

Shiatsu is a Japanese massaging technique originated from traditional Chinese medicine.

In this technique, body manipulation is performed by applying pressure with thumbs, fingers, and palms.

shoulder_shiatsu_massage

  • Deep tissue massage

In a deep tissue massage, deep layers of muscles are targeted for manipulation.

This method is more of an aggressive type since it penetrates deep into muscle tissue to relieve pain and tension.

This massage style might be painful for those who are used to mild massages.

shoulder_deep_tissue_massage

Self-applied massage

To get a good massage you not only can go to a therapist but you can get a body massager and do it yourself.

Here are some benefits of a self-massage:

  • You decide where, when and how much massage you want to receive.
  • You are in control of its intensity and pressure level.
  • You don’t need to get an appointment, take time off from work or pay each time you get a massage.
Body massagers

There are body massagers in the market that incorporate Shiatsu and deep tissue massage techniques.

Buy one of the below massagers and enjoy a self-massage in the comfort of your home.

deep_kneading_shiatsu_massager
Deep-kneading Shiatsu Massager
deep_tissue_percussion_massager
Facial & Deep Tissue Percussion Massager
deep_tissue_massager
Deep Tissue Percussion Massager

► OTC topical pain relief

Another way to ease your muscle pain and soreness is to use over-the-counter topical pain relievers.

These products come in different forms such as:

  • Pain relief cream and gel
  • Pain relief patch
  • Pain relief roll-on
  • Pain relief spray

shoulder_topical_pain_relief

Shoulder Exercises

Stretching and exercise are essential to help you restore your shoulder strength, flexibility, and mobility.

When your shoulder gets strong, the chances are you’d experience less pain.

shoulder_pain_exercises

As part of your treatment, your doctor or therapist will give you a set of exercises to do at home.

There are also plenty of books and online resources with step by step instructions on how to do shoulder exercises for the rotator cuff tears. But make sure to consult with your doctor in advance to see if they are appropriate for you.

The more self-disciplined you are in doing your exercises, the sooner you’d see improvements.

Shoulder exercise tools

Many shoulder workouts require exercise accessories to engage the right muscles and joints.

Below are the most common shoulder rehabilitation exercise tools that you can buy and use during your workout at home:

shoulder_finger_ladder_exercise
Shoulder finger ladder
shoulder_resistance_band_exercise
Resistance Bands
shoulder_pulley_exercise
Overhead Shoulder Pulley


EXTRA: Shoulder Finger Ladder

Learn more about shoulder ladder exercise and how you can do it at home.

Nutrition and Diet

Your overall health and fitness can affect your symptoms and recovery.

A proper diet along with nutritional supplements can improve your health and wellness.
But always check with your doctor before taking any supplements.

healthy_diet

  • Anti-inflammatory diet

Foods that fight inflammation like Mediterranean diet can help reduce pain and swelling in the shoulder.

  • Dietary and herbal supplements

Supplements can help the body reduce pain and inflammation. They can also help with the joints overall health and prevention of re-injuries.
Examples of such supplements include omega-3 (fish oil), Glucosamine and Chondroitin with MSM, turmeric, and ginger.

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Considerations

Please note that the information compiled in this article is from a variety of sources and it may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. Always seek the advice of a doctor or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Learn more

REFERENCES

[1] Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2017). Current medical diagnosis and treatment 2018 (57th ed.). New York: McGraw-Hill.

[2] Standring, S. (Ed.). (2016). Grays anatomy: The anatomical basis of clinical practice (41st ed.). Philadelphia: Elsevier.

[3] Schünke, M., Schulte, E., & Schumacher, U. (2015). General Anatomy And Musculoskeletal System (2nd ed., Vol. 1, THIEME Atlas of Anatomy). New York (NY): Thieme.

[4] Matthewson, G., Beach, C. J., Nelson, A. A., Woodmass, J. M., Ono, Y., Boorman, R. S., . . . Thornton, G. M. (2015). Partial Thickness Rotator Cuff Tears: Current Concepts. Advances in Orthopedics, 2015, 1-11. doi:10.1155/2015/458786

[5] Partial Rotator Cuff Tears. Johns Hopkins Medicine. Retrieved July 12, 2018, from https://www.hopkinsmedicine.org/healthlibrary/conditions/orthopaedic_disorders/partial_rotator_cuff_tears_22,PartialRotatorCuffTears

[6] Edwards, P., Ebert, J., Joss, B., Bhabra, G., Ackland, T., & Wang, A. (2016). Exercise rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. International Journal of Sports Physical Therapy. 11(2), 279-301. PMCID: PMC4827371, PMID: 27104061

[7] Rotator Cuff Tears. American Academy of Orthopaedic Surgeons. Retrieved July 10, 2018, from https://orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears

[8] Linaker, C. H., & Walker-Bone, K. (2015). Shoulder disorders and occupation. Best Practice & Research Clinical Rheumatology, 29(3), 405-423. doi:10.1016/j.berh.2015.04.001

[9] Baumgarten, K. M., Gerlach, D., Galatz, L. M., Teefey, S. A., Middleton, W. D., Ditsios, K., & Yamaguchi, K. (2009). Cigarette Smoking Increases the Risk for Rotator Cuff Tears. Clinical Orthopaedics and Related Research®, 468(6), 1534-1541. doi:10.1007/s11999-009-0781-2

[10] Gomberawalla, M. M., & Sekiya, J. K. (2013). Rotator Cuff Tear and Glenohumeral Instability. Clinical Orthopaedics and Related Research®, 472(8), 2448-2456. doi:10.1007/s11999-013-3290-2

[11] Oliva, F., Piccirilli, E., Bossa, M., Via, A. G., Colombo, A., Chillemi, C., . . . Maffulli, N. (2015). I.S.Mu.L.T – Rotator Cuff Tears Guidelines. Muscles, Ligaments and Tendons Journal, 5(4), 227-263. doi:10.11138/mltj/2015.5.4.227

[12] Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., . . . Wright, R. W. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: A multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 22(10), 1371-1379. doi:10.1016/j.jse.2013.01.026

[13] Yamamoto A., Takagishi K., Osawa T., Yanagawa T., Nakajima D., Shitara H., & Kobayashi T. (2010). Prevalence and risk factors of a rotator cuff tear in the general population [Abstract]. Journal of Shoulder and Elbow Surgery, 19(1), 116-120. doi: 10.1016/j.jse.2009.04.006.

[14] Itoi, E. (2013). Rotator cuff tear: Physical examination and conservative treatment. Journal of Orthopaedic Science, 18(2), 197-204. doi:10.1007/s00776-012-0345-2

[15] Via, A., Cupis, M. D., Spoliti, M., & Oliva, F. (2013). Clinical and biological aspects of rotator cuff tears. Muscle, Ligaments and Tendons Journal, 3(2), 70-79. doi:10.11138/mltj/2013.3.2.070

[16] Dunn, W. R., Kuhn, J. E., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., . . . Wright, R. W. (2014). Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity. The Journal of Bone & Joint Surgery, 96(10), 793-800. doi:10.2106/jbjs.l.01304

[17] AAOS Guideline on optimizing the management of rotator cuff problems: Summary of recommendations. American Academy of Orthopaedic Surgeons. Retrieved July 09, 2018, from https://www.aaos.org/research/guidelines/rcp_summary.pdf

[19] Merolla, G., Chillemi, C., Franceschini, V., Cerciello, S., Ippolito, G., Paladini, P., & Porcellini, G. (2014). Tendon transfer for irreparable rotator cuff tears: Indications and surgical rationale. Muscles, Ligaments and Tendons Journal, 4(4), 425-432. doi:10.11138/mltj/2014.4.4.425

[20] Reverse Total Shoulder Replacement. American Academy of Orthopaedic Surgeons. Retrieved July 12, 2018, from https://orthoinfo.aaos.org/en/treatment/reverse-total-shoulder-replacement/

[21] Ghodadra, N. S., Provencher, M. T., Verma, N. N., Wilk, K. E., & Romeo, A. A. (2009). Open, Mini-open, and All-Arthroscopic Rotator Cuff Repair Surgery: Indications and Implications for Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 81-A6. doi:10.2519/jospt.2009.2918

[22] Cho, C., Song, K., Min, B., Jung, G., Lee, Y., & Sin, H. (2011). Anterolateral approach for mini-open rotator cuff repair. International Orthopaedics, 36(1), 95-100. doi:10.1007/s00264-011-1305-8

[23] Pandey, V., & Willems, W. J. (2015). Rotator cuff tear: A detailed update. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 2(1), 1-14. doi:10.1016/j.asmart.2014.11.003

[24] Green, S., Buchbinder, R., & Hetrick, S. E. (2005). Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews, (2), CD005319. doi:10.1002/14651858.cd005319