The rotator cuff complex consists of four main muscles that stabilise the shoulder joint to allow controlled movement. Such muscles include the infraspinatus, supraspinatus, subscapularis and teres minor. These muscles interact to enable fine and gross motor skills and movement required to take place during activity. Rotator cuff tears often occur due to a sudden and forceful movement. Tendinopathy (tendonitis) can develop when there is frequent overhead movement of the arm. The tendon may not tear but can become very painful.
Causes: Rotator cuff muscle and tendon tears may take place during forceful swinging movements of the arm or when an uncontrolled force is exhibited to the cuff musculature during a specific movement. Degenerative rotator cuff tears may also develop and are common above the age of 40. Shoulder tendonitis is commonly associated with any sporting or daily activity that involves repetitive overhead actions such as tennis, swimming, gardening, painting and other DIY activities. Poor posture can also lead to inflammation of specific cuff tendons leading to similar symptoms.
Symptoms: A feeling of tearing in your shoulder accompanied with general weakness, limited movement and severe pain can indicate a rotator cuff tear. Pain may also be present when lying on the affected shoulder. Tendonitis also causes mild to severe pain with the difficulty of elevating the arm.
Risks and complications: If a rotator cuff injury is not treated promptly, the injury may gradually deteriorate and become more inflamed and painful. The range of movement of the shoulder will become more restricted with the possible development of a bone spur. A frozen shoulder may also develop if physiotherapy is not conducted at an early stage.
Management: A skilled physiotherapist will accurately diagnose the problem and provide treatment to reduce the pain and inflammation. A gradual return to full activity will take place following a graded rehabilitation programme that may involve strengthening and proprioceptive exercises.
There have been three recent studies in 2013 and 2014* that have compared the effectiveness of a physiotherapy programme either instead of surgery or alongside surgical interventions. They looked at patients with varying degrees of non-traumatic rotator cuff tears. The subjects of the study underwent physiotherapy led programmes which combined progressively harder postural, range of movement, and strengthening exercises. This was alongside the use of physiotherapy manual techniques such as massage and joint mobilisations. Overall, the studies’ results showed statistically significant improvements in functional ability, pain levels and a decreased chance of referral for surgery.
*Kuhn et al (2013) Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder Elbow Surg. Oct;22(10):1371-9. PubMed PMID: 23540577.
Kukkonen et al (2014) Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-yr clinical results. Bone Joint J. 2014 Jan;96-B(1):75-81. PubMed PMID: 24395315.
Moosmayer et al (2014) Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-yr follow-up. J Bone Joint Surg Am. 2014 Sep 17;96(18):1504-14. PubMed PMID: 25232074.