Rotator cuff tear
A rotator cuff tear affects one or more of the tendons that lift and turn the arm. It can happen suddenly after an injury or develop slowly over time, and may cause pain, weakness and trouble sleeping or reaching overhead. Many tears are managed well without surgery.
At the Specialist Orthopaedic Surgery Clinic in East Melbourne, orthopaedic assessment, physiotherapy, myotherapy and strength testing all happen in the same rooms, so your plan can be matched to the tear and to what you need your shoulder to do.
What is a rotator cuff tear?
The rotator cuff is a group of four tendons that connect the shoulder muscles to the top of the upper arm bone. They help lift and turn the arm and keep the ball centred in the socket.
A tear may involve part of a tendon or go right through it. Some tears cause little trouble, while others lead to pain, weakness or loss of function. The size of a tear does not always match the level of pain, and tears are often found in people with no symptoms at all.
Does this sound like you?
Arrange an assessment if shoulder pain or weakness persists, disturbs sleep, limits lifting or overhead activity, or has not improved with rehabilitation.
How it is diagnosed
Diagnosis starts with how the symptoms began and how they affect sleep, lifting and overhead use. Shoulder movement and strength are tested in different positions, and the neck is checked as another possible source of pain.
Ultrasound or MRI shows where the tear is and how large it is. MRI also shows how far the tendon has pulled back and the quality of the muscle, which helps when surgery is being considered.
Treatment and recovery
Treatment depends on whether the tear is recent or long-standing, its size, the quality of the tendon and muscle, and what you need your shoulder to do. Many people start with activity changes, physiotherapy and pain relief.
First weeks
Settle the pain
Activity is adjusted to limit repeated painful lifting while keeping the shoulder moving in a comfortable range. Short-term pain relief can be discussed with your GP.
Physiotherapy
Build control
Exercises train the shoulder blade, deltoid and remaining rotator cuff so the arm can lift well despite the tear.
Building up
Strengthen and return
Load is increased gradually for work, sport and overhead tasks. Strength testing can measure progress and guide return to work.
If progress stalls
Review the plan
If pain or weakness remains limiting despite a structured program, further imaging or a surgical opinion may be arranged.
Exercises you may be given
Your physiotherapist will choose the right ones and the right level for you.
Pendulum swings
Lean on a bench and let the sore arm hang. Rock your body so the arm swings in small, relaxed circles.
30 seconds, a few times a day
Shoulder blade squeeze
Sit or stand tall. Draw your shoulder blades gently back and down, hold, then relax. Keep your neck soft.
10 holds of 5 seconds
Outward press against a wall
Elbow bent and tucked in. Press the back of your hand gently into a door frame without moving. Hold, then relax.
5 holds of 20 to 30 seconds
Side-lying rotation
Lie on your good side with a towel under the elbow. Slowly lift a light weight by turning the forearm up, then lower it.
2 to 3 sets of 10, slow
Other treatment options
Injections
A corticosteroid injection may give temporary relief when pain is stopping useful rehabilitation. Repeated injections are generally avoided, and an injection does not heal the tear. Injections are not given at the clinic. If one is recommended, your GP can arrange it, usually through a radiology practice.
When surgery is needed
Rotator cuff repair may be considered after a recent injury with significant weakness, or when pain and loss of function remain limiting despite a structured program. A tear found on a scan without matching symptoms is not a reason for surgery. Prof Phong Tran performs rotator cuff repair, and his website explains the options and recovery.
Common questions
Does every rotator cuff tear need surgery?
No. Many tears are managed with physiotherapy, activity changes and pain relief, particularly when strength and function remain good.
Can a rotator cuff tear heal by itself?
A full-thickness tear usually does not reattach by itself, but pain and function can still improve a great deal without surgery.
Why can a painless tear show up on a scan?
Tears become more common with age and are often present without symptoms. Scan findings are always matched with your pain, strength and function.
Should I rest the shoulder completely?
No. Gentle use within comfort and a guided exercise program usually help more than prolonged rest.
When is repair considered?
Repair may be discussed after a recent injury with significant weakness, or when symptoms remain limiting despite rehabilitation.
Book an assessment
An assessment can confirm the diagnosis and match treatment to your tear and your goals. Physiotherapy with A/Prof Amir Takla and Imogen Clark, myotherapy with Joanne VanDer Haar, and specialist review with Prof Phong Tran, all at 166 Gipps Street, East Melbourne. Please bring any previous ultrasound or MRI reports and details of treatment already tried. Read about physiotherapy for rotator cuff problems.