Rotator Cuff Tear

Find personalized care for your type of rotator cuff injury at EvergreenHealth. Count on our fellowship-trained shoulder surgeons and sports medicine specialists for precise care designed to relieve pain and let you comfortably use your joint again.

Causes of Torn Rotator Cuff

Rotator cuff tendon tears are a common cause of shoulder pain and affect millions of people each year. Typically, tendon tears are associated with sports injuries or injuries in young people, but the majority of rotator cuff tendon tears occur gradually with age, as people perform the same overhead tasks again and again. Fortunately, not all rotator cuff tears are painful.

There are four rotator cuff tendons that surround the ball of the shoulder joint. Their primary purpose is to control shoulder rotation, although they also keep the ball of the joint centered in the shallow cup of the joint.

The shoulder joint is much more flexible than the other joints in your body, such as your hips and knees. So while other joints can depend on the shape of the bones in order to function properly, the shoulder depends on the muscles and tendons in order to work correctly and maintain flexibility. As a result, rotator cuff tendons are more prone to injury than the tendons in your other joints.

Signs & Symptoms

Depending on the size of your rotator cuff tear, you may experience:

• Pain in the front and side of the shoulder
• Pain that spreads down the arm and may make you feel like you have an arm injury
• Trouble reaching up, to the side, or behind your back
• Shoulder weakness

The most commonly torn rotator cuff tendon is the supraspinatus tendon, which is the tendon on the top of the shoulder joint. When this tendon tears, it can cause pain in the front and on the side of the shoulder and can be severe enough to wake you up at night and keep you from sleeping on your side.

Diagnosis

To diagnose a rotator cuff tendon tear, your doctor will need to perform a complete exam of your shoulder. This will include a physical examination as well as an imaging test.

An X-ray will be needed to make sure there are no other issues with the joint, and to look for bone spurs or calcium deposits in the tendon. An MRI may be needed if the diagnosis cannot be made by exam and X ray alone.

Physical Therapy

Your best treatment may be physical therapy if your rotator cuff tear is small or isn't the right type for surgery. Over a few months, a caring EvergreenHealth therapist will help you:

• Relieve pain with hands-on soft-tissue techniques
• Do exercises to strengthen your shoulder
• Adjust how you do daily tasks to prevent symptoms

You'll also find out how to prevent another rotator cuff injury, so you can enjoy fuller use of your shoulder for years to come.

Surgical Rotator Cuff Repair

If your doctor recommends surgery, you'll benefit from EvergreenHealth's less invasive, arthroscopic approach. Instead of making a large incision, the surgeon makes small incisions and inserts a tiny camera and pencil-thin surgical tools inside your shoulder. Then, the surgeon reattaches the torn tendon to bone.

Your recovery will be easier because the surgery is minimally invasive. But the tendon must heal after the procedure, and it may take several months for pain to go away. Your shoulder strength should return within a year as you take part in orthopedic rehabilitation.

Recovery Timeline

Treatment: Regain full passive motion using twice daily stretching exercises. The stretches should focus on internal rotation, external rotation and forward elevation and they should only consume 15 minutes of the patient’s time to do them all. Once passive motion is normal, start an isometric strengthening program without therabands. No external rotation past neutral or away from the body. No exercises should cause pain.

If the patient is unable to elevate the arm above shoulder height without weights, then a supine strengthening program should be started.

Duration: Two times a week for 8 weeks.

Modalities may be used as indicated. This includes biceps tendon repairs done at the same time.

• 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 you can learn the stretches to do at home three 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 can keep your arm in the sling.
• 6 weeks: Stop using the sling. No lifting more than a coffee cup with the impacted arm. You will continue your therapy and 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 5 lbs. 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.