A Physical Therapy Guide to a Rotator Cuff Tear
The shoulder achieves an ideal combination of stability and mobility with the help of the rotator cuff. Aging, overuse, trauma, or any other type of accident can result in a rotator cuff tear.
In this guide, we will explore rotator cuff tear symptoms, causes, and physical therapy treatment.
Physical therapy is a highly effective form of treatment for a rotator cuff tear.1
- Understanding a Rotator Cuff Tear
- Symptoms of a Rotator Cuff Tear
- Common Causes of Rotator Cuff Tears
- Diagnosing Rotator Cuff Tears
- What to Expect from Physical Therapy for a Rotator Cuff Tear
- Can a Rotator Cuff Tear Heal Itself?
- How to Prevent a Rotator Cuff Tear
- Is it Time for PT Treatment?
Traditionally, there are four muscles in the rotator cuff: the supraspinatus, subscapularis, infraspinatus, and teres minor. The rotator cuff muscles and tendons attach the shoulder blade (scapula) to the upper arm bone (humerus).
These muscles work together to primarily stabilize the shoulder joint with arm use. A rotator cuff tear occurs when one or more of the tendons or muscles is torn.
There are two types of rotator cuff tears:
- Partial tear: These types of tears can range from small (less than 1 cm) to large (up to 5 cm).
- Full thickness tear: A full-thickness tear means that one or more of the tendons (or muscles themselves) have been completely torn.
Symptoms of a rotator cuff tear can onset acutely with a traumatic injury or accident, such as a fall or sports impact. Alternatively, they can be present chronically due to an ongoing shoulder injury or repetitive strain. Common symptoms include:
- Shoulder pain, ranging from dull and achy to sharp with arm use
- Pain that radiates across the top or down the side of the shoulder
- Weakness in the shoulder
- A feeling of heaviness in the affected arm
- Loss of normal shoulder range of motion
- Shoulder stiffness
- Difficulty completing normal daily activities, such as reaching overhead and behind the back
Let's review the most common reasons that a rotator cuff tear can occur:
- Degenerative changes to the shoulder joint from a previous injury or aging
- Overuse or repetitive stress to the rotator cuff muscles and tendons
- Traumatic injuries, such as a fall or direct blow to the shoulder
- Shoulder dysfunction due to faulty biomechanics that put excessive strain on the shoulder, typically secondary to an injury or onset of pain
Additionally, some conditions can lead to a rotator cuff tear due to deterioration of both local and global tissue health. These include:
- Autoimmune diseases, such as rheumatoid arthritis
- Circulatory compromise, local or general from heart disease
- Intrinsic structural issues in the shoulder
If you want to start your road to shoulder recovery, it's time to book an appointment with a physical therapist.
Your physical therapist will conduct a thorough examination at your first visit. This will include asking about your medical history and symptoms. Understanding the specific details of your shoulder symptoms, such as when they started and what aggravates them, is important for diagnosis. Plus, your physical therapist will be interested in how and when your shoulder pain affects your daily activities.
Next, your therapist will complete a physical examination. They will palpate, and look at shoulder range of motion, strength, and function such as reaching overhead. They may also perform special tests to determine the exact area affected and rule out other causes of shoulder pain.
If your injury occurred acutely or your physical therapist suspects a large tear (or other underlying issues), they can recommend asking your physician for further imaging, such as an MRI, ultrasound, or CT scan.
If your rotator cuff injury occurred suddenly, you will most likely work with your physical therapist and orthopedic doctor to determine whether surgery is necessary or not. They will analyze certain indicators to help you decide what's best. On the other hand, a chronic injury is typically best treated conservatively to address the underlying dysfunction.
Regardless of the final decision, your physical therapist will help you restore shoulder movement and function. That way you can get back to your normal daily activities with confidence as soon as possible.
Specific treatment options you may encounter include:
- Post-surgical guidance: First protecting the joint and then gradually moving, restoring range of motion, and strengthening it.
- Pain management: Use of short-term passive modalities, such as electrical stimulation and ice, to reduce swelling, and pain, and improve tolerance for movement.
- Therapeutic exercises: Targeting the shoulder, upper body, and core, to improve flexibility, coordination, endurance, and overall daily function.
- Manual therapy techniques: Such as shoulder and spine mobilization, soft tissue massage, tendon cross friction massage, myofascial techniques, dry needling, and more. To help improve range of motion and reduce pain.
- Neuromuscular reeducation: To help relearn proper muscle firing patterns and movement strategies for optimal shoulder stability, tissue healing, and mechanics.
- Ergonomic and activity modification guidance: To help you understand how your daily activities and posture may be affecting your shoulder and what you can do to modify them.
- Education: On everything from pain management to joint protection strategies, so you can better manage your condition and symptoms long-term.
There is no definitive answer to this question, and it seems to depend on who you ask. Plus, the issue is complicated since it's been found that over 60% of rotator cuff tears caused by degeneration are asymptomatic.2
There are a few factors that will determine the shoulder's healing capabilities:
- Whether there's enough blood perfusion
- The severity of the tear
- Whether the original causes of the tear can be removed or modified (most important with chronic tears)
Physical therapy will help optimize local blood flow and reduce unnecessary strain on the shoulder, giving your shoulder the best chance of recovery, whether surgery is required or not. With smaller tears, it is likely that you can fully heal without any invasive treatment options.
Unfortunately, there's no guaranteed way to prevent a rotator cuff tear. However, here are a few good tips to keep in mind:
- Exercise: Maintain good shoulder (and spine) range of motion and strength through regular stretching and strengthening exercises. A weak rotator cuff can result in more severe tissue damage if a fall or trauma occurs to the shoulder.3
- Activity modification: Avoid or take frequent breaks from activities that require repetitive overhead motions or put excessive strain on the shoulder.
- Make healthy lifestyle choices: Sleep, diet, and stress can all affect the health of the body's tissues.
- Ergonomics: There are several joints that all need to move in coordinated balance to maintain optimal health, including joints of the chest, spine, shoulder blade, and collar bone. Maintaining good postural alignment in the positions you are in most often will reduce shoulder strain.
Shoulder pain and dysfunction resulting from a rotator cuff tear can make it feel impossible to complete your normal daily activities. We need our shoulders to reach for something in the pantry, wash behind our backs, push a stroller or shopping cart, and so much more.
Ready to get back to normal life? We can help! Schedule an appointment with one of our CityPT orthopedic specialists today.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Narvani AA, Imam MA, Godenèche A, Calvo E, Corbett S, Wallace AL, Itoi E. Degenerative rotator cuff tear, repair or not repair? A review of current evidence. Ann R Coll Surg Engl. 2020 Apr;102(4):248-255. doi: 10.1308/rcsann.2019.0173. Epub 2020 Jan 3. PMID: 31896272; PMCID: PMC7099167. ↩
Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K, Kijima H, Itoi E. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013 Feb 26;10(1):8-12. doi: 10.1016/j.jor.2013.01.008. PMID: 24403741; PMCID: PMC3768248. ↩
Physiopedia. Rotator Cuff Tears. Physiopedia.com. Accessed July 1, 2022. https://www.physio-pedia.com/Rotator_Cuff_Tears#cite_ref-Horng-chaung_et_al._3-0 ↩