A tear in the rotator cuff is one of the most common injuries of the shoulder and is a frequent cause of pain and disability in adults. When one of the rotator cuff tendons tears, it can no longer support the shoulder joint.
A tear in the rotator cuff tendons can make it difficult to perform simple tasks, such as putting on and removing a shirt or combing one’s hair.
A rotator cuff tear can become more significant if not treated correctly or if the shoulder is used continually and placed under the same stress despite increasing pain and weakness.
Rotator cuff tears are classified into two types:
- Partial-thickness tear: An incomplete tear that results in partial damage of the tendon. A partial tear could also progress into a full-thickness tear if the injury is left untreated
- Full-thickness tear: A complete tear resulting in the entire tendon rupturing.
Early treatment is necessary to:
- Prevent further damage to the tendon.
- Avoid related injuries in the shoulder joint and muscles.
The treatment goals for a rotator cuff tear are to:
- Decrease pain.
- Restore the shoulder to normal or close-to-normal function.
There is no evidence to suggest that surgery in the early stages is more beneficial than performing it later. Surgery could also cause complications such as infection, permanent stiffness and longer recovery time.
Therefore, experts usually require the individual to undergo conservative treatment, such as physical therapy and other non-surgical treatments, before pursuing more invasive treatment.
Although 80% of individuals get better with non-surgical interventions, there is still a chance to not work on some patients.
One of the disadvantages of non-surgical treatment is the possibility of the size of the tear increasing. The tear can increase if:
- The treatment protocol is not strictly followed.
- The individual continues to use the shoulder despite having pain.
In general, doctors recommend surgery if all conservative treatments have been exhausted.
Can a Torn Rotator Cuff Heal on Its Own Without Surgery?
Doctors usually prescribe patients with non-surgical procedures before recommending surgery. In most cases, rotator cuff tears can heal with conservative treatment.
The following are some of the non-surgical treatments for rotator cuff tear:
- Resting the affected shoulder and limiting excessive movements such as overhead reaching and heavy lifting. A physician may recommend a sling to prevent unnecessary motions and allow healing.
- Modifying the activities to avoid triggering pain in the affected shoulder, such as using a stool when reaching for overhead cupboards and using buttoned shirts instead of pull-on t-shirts.
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen to manage the pain and swelling.
- Attending physical therapy sessions strengthens the muscles, prevents loss of motion, and teaches proper body mechanics and activity modification techniques to manage pain and prevent the injury from worsening.
- Taking steroid injections if rest, NSAIDs, and physical therapy interventions did not improve the symptoms. Cortisone is proven to help manage pain; however, it may not be beneficial to all patients.
- Read about the Best Shoulder Brace for Rotator Cuff Injuries.
What Are the Signs That a Rotator Cuff Tear Would Require Surgery?
The primary factor for surgery is continued pain after all conservative treatments have been exhausted.
If the individual actively engages in sports or other recreational activities, is an athlete, or is employed in a job requiring repetitive use of the shoulder such as painting, surgery may also be prescribed.
Other factors that may indicate the need for surgery are:
- Symptoms that continue for 6 to 12 months.
- A tear that is larger than 3 cm if the surrounding tissues are in good shape.
- There is substantial weakness and functional impairment.
- A new and acute injury causes the tear.
How Do You Treat a Torn Rotator Cuff at Home?
Aside from resting the affected shoulder, the following may be beneficial for faster recovery:
- Taking nutritional supplements
- Vitamin D and calcium improve the tendon-bone healing process by increasing bone density and strengthening the muscles.
- Vitamin C has antioxidant and anti-inflammatory properties, which could help decrease pain and inflammation. Since protein is the main building block for muscles, it is crucial to get adequate protein to lower the risk for atrophy or muscle loss and avoid slow recovery time.
- Stop smoking
- The nicotine in cigarettes slows down the healing process, especially after surgery. Smoking is associated with infection and poor healing as nicotine could cause narrowing of the blood vessels, resulting in a lower blood supply.
- Changing one’s sleeping position
- Lying down on the injured shoulder usually causes pain. Therefore, lying on the unaffected side or one’s back is recommended to prevent impinging and putting weight on the affected shoulder.
- Perform strengthening and stretching exercises.
- Resistance and stretching exercises for the elbow, hand, and wrist must begin immediately, especially when immobilization has been prescribed, to maintain strength and range of motion.
- One can perform low-load exercises for the affected shoulder provided that a physical therapist is present to guide the patient.
- The intensity and duration of exercises should progress slowly depending on the capacity of the individual.
- Avoid exercises that cause pain.
- All exercises that trigger or worsen pain in the affected shoulder should cease immediately.
- One shouldn’t perform exercises that require overhead motion and lifting without the clearance of a doctor or a physical therapist.
How Long Does It Take for a Torn Rotator Cuff to Heal Without Surgery?
A rotator cuff tear treated with conservative intervention could heal in an average of four to six months, depending on the extent of the tear.
At six months, provided that the pain has decreased considerably and the muscles are stronger, one can restart most daily activities. However, complete recovery may take up to one year.
How Can a Rotator Cuff Tear Be Prevented?
Stretching and strengthening exercises under the guidance of your physiotherapist can help improve the flexibility of muscles and tendons. Regular stretching and strengthening exercises improve the range of motion and prevent future injury.
People with jobs requiring repetitive use of the shoulder should take frequent breaks to rest their shoulder.
Rotator Cuff Muscles
The shoulder is composed of three main bones: the bone of the upper arm (called the humerus), the shoulder blade (called the scapula), and the collarbone (called the clavicle).
The upper end of the humerus has the shape of a ball and fits in the shallow socket of the scapula. This ball and socket joint allows the shoulder to move in different directions.
Four muscles comprise the rotator cuff: the supraspinatus, infraspinatus, teres minor and the subscapularis.
The muscles and their tendons surround the shoulder, connecting the scapula to the humerus. This connection forms a “cuff” to stabilize the shoulder during movement.
What Are the Causes of Rotator Cuff Tears?
There are two common causes of rotator cuff tears:
Occurs during accidents such as falling on an outstretched hand, lifting extremely heavy loads and sports-related or motor vehicle accidents.
Occurs as a result of the regular wearing down of the tendon as one ages. Some of the factors that contribute to degenerative tear are:
- Repetitive stress when performing the same motions over time.
- Poor blood supply to the tendons, which usually happens as one gets older.
- Bone spurs or bone growth, which develops in the acromion process, the bony process of the scapula that is also part of the shoulder. The spurs rub on the tendon, damaging it as the shoulder moves.
Who Is at Risk of Experiencing Rotator Cuff Tear?
Certain factors such as older age (40+), smoking, or a strong family history of rotator cuff injuries, increase the risk of rotator cuff tear.
Degenerative tears are more common in carpenters, mechanics, painters, and athletes who play sports such as basketball, tennis, rowing, and other sports which involve overuse of the shoulder.
What Are the Common Rotator Cuff Injury Symptoms?
Some common symptoms of rotator cuff tear are:
- Pain felt at rest, especially at night. It is usually difficult for the individual to lie down on the side with the affected shoulder.
- Pain during specific movements or activities such as lifting objects or lowering the arm to put an object down.
- Weakness of the shoulder muscles, making it difficult to perform daily tasks.
- The feeling of cracking or popping in the shoulder joint, called crepitus, during specific shoulder motions.
Rotator cuff tears resulting from an acute injury, such as an injury sustained in an accident, are extremely painful. One may also feel a cracking or snapping sensation at the time of injury. One may also experience Immediate weakness of the shoulder.
Tears that occur due to degeneration may not be painful at first. One may feel pain only during specific movements such as heavy lifting or overhead reaching. One may also feel some weakness in the shoulder, but this can be quickly relieved through over-the-counter medications.
The pain and weakness will develop slowly over time, and as the degeneration progresses, one may feel pain at rest, and medication may no longer relieve the feeling of weakness.
Do’s and Don’ts after Rotator Cuff Surgery
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.