What a rotator cuff tear is
The rotator cuff is four muscles whose tendons wrap around the head of the humerus and hold it in the socket during every movement of the arm. The tendon most often damaged is that of supraspinatus, which runs beneath the acromion of the shoulder blade.
Tears fall into two groups with completely different courses. The first, much larger group is degenerative tears: the tendon thins over the years, and a tear develops without any clear injury, usually after the age of 50. Changes like these are often seen on ultrasound in people who have no symptoms at all – which is why an imaging result on its own does not yet explain the pain. The second group is traumatic tears: a fall, a jerk or a shoulder dislocation, after which the arm suddenly loses strength. Sometimes a minor injury affects a tendon already weakened by degenerative changes – then treatment is decided not only by the imaging result but, above all, by how much strength and movement remain in the shoulder.
Exercise or surgery
With degenerative and partial tears, treatment starts with physiotherapy. Studies comparing the two approaches show that a well-run exercise programme gives many patients an improvement in pain and function similar to that after surgery. Physiotherapy will not “knit” the tendon back together, but it allows the remaining rotator cuff and shoulder blade muscles to take over part of its work, and the tendon itself to regain its tolerance to load.
The situation is different after a recent injury in a younger, active person. If after a fall or a sudden pull on the arm you cannot lift your arm, although the shoulder worked normally before, do not wait for it to “pass”. A full-thickness traumatic tendon tear is worth discussing with an orthopaedic surgeon as soon as possible, ideally within a few weeks of the injury, because over time the muscle retracts and the chances of a successful repair shrink. If the examination at the first visit points to this, we refer you to a doctor instead of starting exercise.
Rehabilitation after rotator cuff repair
After a repair, the tendon needs time to heal onto the bone, so rehabilitation proceeds in stages, with the timings set by the surgeon. In the first weeks the arm is usually in a sling, and we work on passive shoulder movement and on the mobility of the shoulder blade, elbow and neck – without actively lifting the arm. Active movement comes later, and resistance exercises usually only several months after the operation.
The skill lies in not getting ahead of healing while also not letting the shoulder stiffen, which is not uncommon after this operation. That is why at every visit we check the range of motion and how the joint responded to the previous dose of exercise.
How we work and what to expect
Whether we are carrying out conservative or post-operative treatment, the foundation is gradual loading – first gentle contractions, then resistance through an increasing range, and finally overhead work and work with weights. Manual therapy and soft tissue work help control pain, but the strength that protects the shoulder is built by medical training. With conservative treatment the first improvement is usually visible after a few weeks, and the full effect after several months of regular exercise.
If your symptoms look more like tendon overload than a tear, you can read more on the page about shoulder pain. For the first visit, bring your imaging results and, if you have had surgery, the operation notes with recommendations. You can arrange an appointment via the Contact page.