The term "rotator cuff tear" often causes confusion, and many people don't fully understand what it really is or how it affects the body. To clarify your understanding, we are here to explain the basic anatomy and management of the rotator cuff.
WHAT IS ROTATOR CUFF?
The rotator cuff (RC) is a common term for the group of four distinct muscles and their tendons that provide strength and stability during shoulder motion. These muscles are also referred to as the SITS muscles, based on the first letter of their names: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. Although many factors influence the treatment of rotator cuff tears, understanding the anatomy and its relation to function is the most important factor.
Rotator cuff tear refers to an injury to the muscles and tendons that stabilize the shoulder joint. A tear in any of these muscles or their tendons can cause pain, weakness, and limited range of motion in the shoulder.
TYPES OF ROTATOR CUFF TEAR
PARTIAL TEAR
A partial tear to rotator cuff occurs when the tendon connecting the shoulder muscles to the arm bone is partially damage but still maintains some attachment. In such cases the tendon is not completely separated from the bone.
COMPLETE TEAR
A complete tear of the rotator cuff also known as the full thickness tear, occurs when the tendon Is completely detached from the bone. Causing more severe injury.
WHO IS AT RISK?
SPORTS SPECIFIC INJURY
Overhead Sports
Sports involved repetitive overhead motion, such as baseball, tennis, and swimming, are known to place significant strain on the rotator cuff. These activities require extensive use of the shoulder joint, increasing the risk of overuse injuries like rotator cuff tendinitis or tear.
Weightlifting
Weightlifting involved heavy shoulder presses during this the excessive strain placed on the shoulder joint and the surrounding muscles can led to strain, tear or impingement it is crucial in these activities to prioritize correct form, start with the lighter weights and then progress to higher weights.
Racket sports
Sports such as badminton, squash and racquetball involve repetitive arm movements while holding a racquet. These actions, combined with the high impact nature of the sport can increase the chances of rotator cuff injuries, improper technique, a powerful swing without proper warm up, or inadequate rest periods can contribute to tendinitis and rotator cuff tear.
Contact and collision sports
Sports like football, rugby and wrestling involve forceful collision, resulting in a higher risk of shoulder injuries, including rotator cuff tear. Direct impact falls and tackles can put immense pressure on the shoulder joint, leading to instability or the tearing of the rotator cuff tendons. Athletes participating in contact sports should wear proper protective gear, practice proper tackling technique and focus on shoulder stability exercise minimise the risk.
AGING
THE natural aging process can contribute to the development of rotator cuff problems. As the age increases the blood supply to tendons decreases making them more prone to degeneration and tears.
GENETICS
Family history of shoulder injuries can increase the susceptibility to rotator cuff tears.
LIFESTYLE FACTORS
Smoking can impair blood flow to the tendons, hindering the healing and increasing the risk of tears.
POOR POSTURE
Improper posture can lead to strain on the rotator cuff muscles thereby leading to increased risk of tear.
Symptoms can include:
Pain: Often felt on the outer side of the shoulder and may worsen at night. Pain when performing activities like lifting, throwing, or overhead movements.
Weakness: Difficulty lifting the arm or performing overhead motions.
Restricted range of motion: Trouble with activities like reaching behind the back
Clicking or popping: A sensation in the shoulder during movement, along with decreased range of motion
Diagnosis criteria can include
Physical Examination that includes assessment of the shoulder joint and its movements and strength.
Imaging: MRI or ultrasound may be used to visualize the extent of the tear.
Dynamometer testing
Treatment
Treatment includes conservative and surgical management depending on the severity of the condition.
Conservative management includes
Physiotherapy treatment in which the various techniques are used.
Initial Phase (Pain and Inflammation Management)
Rest: Avoid activities that aggravate the pain.
Ice: Apply ice packs to the shoulder for 15-20 minutes at a time, several times a day
MOBILIZATION
Grade 1 mobilization to reduce pain.
Range of Motion Exercises: Start with simple pendulum exercises and progress to gentle stretches as tolerated.
OPEN CHAIN EXERCISES
Side-lying external rotation
Lie on uninvolved side, with a small pillow between involved arm and body. Keep the elbow of involved arm bent and fixed to side, raise the arm into external rotation. Slowly lower to starting position and repeat.
Shoulder extension
Lie in prone position on a table. The involved arm is hanging straight to the floor. With the thumb pointed outward, raise the arm straight back toward your hip. Slowly lower the arm and repeat.
Prone horizontal abduction
Lie in prone position on a table. The involved arm is hanging straight to the floor. With the thumb pointed outward, raise the arm out to the side, parallel to the floor. Slowly lower your arm and repeat.
90/90 external rotation
Lie in prone position on a table. The shoulder is abducted to 90° and the arm is supported on the table. The elbow is bent at 90°. Keep the shoulder and elbow fixed and rotate the arm into external rotation. Slowly lower to starting position and repeat.
EXAMPLE CLOSED CHAIN EXERCISE
Wall push ups
Wall push ups are a helpful exercise for rotator cuff rehabilitation because they help strengthen the muscles that support the shoulder joint without putting too much stress on the injured area.
Scapular retractions
These are exercises that involve pulling your shoulder blades together towards your spine. They are often used in physiotherapy for rotator cuff tears to improve shoulder stability and function.
Face pulls
It is a great exercise for strengthening the muscles that support the shoulder joint, including the rotator cuff.
Late Phase (Strengthening and Functional Activities)
Functional Exercises: Incorporate activities that mimic daily tasks and sports-specific movements.
Return to Activity: Gradually return to normal activities and sports, as tolerated.
Plyometric drills
Surgical Intervention: If conservative treatments fail, or if the tear is large or severe, surgery may be needed to repair the torn tendons. This can involve arthroscopic surgery (minimally invasive) or open surgery.
Recovery from a rotator cuff tear can take time, especially after surgery, and typically includes rehabilitation with physical therapy to restore strength and motion. To get back to the normal day to day activities without pain.
NOTE* These are examples of the exercises do not do them unless prescribed by your physiotherapist.
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