Partial Rotator Cuff Tear

Partial rotator cuff tears are responsible for pain and loss of arm function in thousands of people every year.

The pain is usually located on the side and front of the shoulder, and it is made worse when patients try to raise their arms to the side and above their shoulders. When the partial tear worsens, patients can experience pain when making any motion away from their side, and the constant ache can keep them awake at night.

The diagnosis of a partial rotator cuff tear can be made by an experienced doctor who listens to the patient’s symptoms and performs a thorough physical exam.

An x-ray may be taken to eliminate other common causes of shoulder pain, such as calcific tendonitis or arthritis.

An MRI of the shoulder is only needed if physical therapy does not work as expected. For a partial rotator cuff tear, an MRI will show a thin, worn tendon with fluid on top of it from the irritation.

In order to understand how physical therapy and other treatment options eliminate shoulder pain, you first need to understand how the rotator cuff works.

The Rotator Cuff

The end of the arm bone is a ball that connects to a shallow cup in the shoulder blade bone. Four different muscles connect to the ball through four tendons, which are needed to move the ball of the shoulder in the cup.

The tendons blend together around the shoulder ball. If some of the tendon detaches from the bone, then the muscles cannot rotate the arm bone, and you will feel weakness in the arm.

Eventually the tendon will tear completely, but before that happens, it becomes worn, similar to a frayed shoe lace that is about to break. This is a partial tear of the rotator cuff. The tendon is still attached, but it is worn and thin.

Irritation of the partially torn tendon can cause mild to severe pain, depending on the size of the tear and the amount of irritation it causes in the tissue around the tendon.

How do you treat a partial rotator cuff tear?

The goal of treating a partially torn rotator cuff tendon is to allow the irritation of the tendons and the bursa around the tendons to cease. This can be done with rest, activity modification, ice, heat and over the counter pain medications. Once the pain improves, a physical therapy program can be used to:

• Regain any loss of motion of the shoulder.
• Strengthen the muscles around the shoulder blade.
• Practice proper posture and shoulder mechanics to avoid unnecessary stress on the rotator cuff tendons.
• Strengthen the other rotator cuff tendons that are not partially torn.
• Return to normal activities.

Accomplishing all five goals can take several months.

Some patients are unable to participate in physical therapy because the pain from the partial tear is too severe.

If your pain is too severe for physical therapy, a steroid injection around the irritated tissue on top of the rotator cuff can stop the pain, allowing you to do therapy.

The injection is not a cure for the problem, but temporarily alleviates the pain so that you can focus on treatment. Some patients need more than one injection, and while multiple steroid

injections can cause tendon damage, the risk is small unless multiple injections (more than 3 to 4) are given in a short period of time (i.e. 12 months).

Surgery For Partial Rotator Cuff Tears

If 8 to 12 weeks of therapy and an injection do not help alleviate the pain of a partial rotator cuff tear, surgery can be considered as a treatment option.

The surgery can be done arthroscopically. An arthroscope is an instrument with a tiny camera on the end that can be inserted through small incisions around the shoulder and used to examine the shoulder and rotator cuff tendon.

The irritated bursa on top of the tendon will be removed, along with any bone spurs that may be contributing to the pain. If the partial tear can be repaired, the surgeon will place sutures through the end of the tendon and tie the tendon to the bone.

The sutures will hold the tendon against the bone so that it heals there. This healing process takes 12 weeks, so you must protect the arm while the tendon is healing.

Any lifting or reaching with the arm could pull the tendon through the sutures, meaning the repair will not heal. After the tendon heals, the patient can start a physical therapy strengthening program.

The entire recovery can take a full year, but most patients no longer feel a constant ache in the shoulder after 6 to 8 weeks.

Recovery Timeline

• First 2 weeks: Keep the sling on except for showers and stretching. Bend the elbow twice a day. No reaching, lifting or pushing. You will be able to type on a keyboard as long as you bring the keyboard to your lap so you don’t have to reach with your arm. You can use your hand to hold a phone, but nothing more.
• 2 weeks: You will start therapy so they can teach you the stretches to do at home 3 times a day. Bend the elbow twice a day. Keep the sling on all other times. You may drive if you are no longer taking pain medications and you keep your arm in the sling.
• 6 weeks: Stop using the sling. No lifting more than a coffee cup with the arm. You will continue with therapy and you will start stretching the arm behind your back.
• 12 weeks: Continue stretching. Most patients are able to get their hand above their head and to their belt behind their back. The motion will not usually be the same as the other shoulder by this time. It is ok to start lifting 5lbs occasionally, but no repetitive lifting yet. You will start a strengthening program with your therapist.
• 5-6 months: Most patients can do normal activities around the house and office at this time. High level sports like golf, basketball, tennis and swimming can start now. Most patients are able to transition to doing all their exercises at home by this time and graduate from physical therapy.