I Have a Rotator Cuff Tear … Now What?

Have you had shoulder pain for some time, only to be told after having a scan you have a rotator cuff tendon tear? Misplaced fear may be your first reaction if the consequence of a rotator cuff tear has not been explained well.  

A tear in the rotator cuff is common. And it may be there for a while before you notice any pain. Rotator cuff degeneration is a normal part of the aging process just like getting wrinkles or grey hair. If you think about it, it makes sense that we age on both the outside and inside! In fact, a high proportion of the population (particularly people over 50 years) will have a rotator cuff tear show up on scans, even if they don’t experience any symptoms. 

For this reason, in addition to considering your scan results, a Physiotherapist will listen to your shoulder pain story and assess clinical signs (shoulder movement, strength, pain behaviour). This is more useful than the actual scan in guiding your treatment plan. Our Physiotherapists at Physiotas are trained to assess and consider all factors relevant to your shoulder pain. This includes identification of any previous trauma, your age, the size and location of the tear and other general health details. Your physiotherapist will work with you to determine the most appropriate treatment pathway, and help you set and achieve realistic goals. In a few cases, surgery is required, such as a large tear resulting from a traumatic event (like a fall). But in most cases, exercises for at least 8-12 weeks are the first point of call. 

How can the rotator cuff work if it’s torn?   

The rotator cuff muscle group consists of four muscles and tendons that attach onto the humerus (upper arm bone). Together they form a sleeve-like structure and help maintain stability and move our mobile shoulder. Over time this structure can gradually become a little thin and a hole develops, much like a small hole in a sock. The sock still functions and stays on the foot, despite the hole, because the rest of the sock is strong. This is true for the rotator cuff as well. If the tear or hole has developed gradually, and the rest of the cuff is strong and effective, the shoulder will continue to function well. That is why around 60% of people aged 60 years or more have a rotator cuff tear with no symptoms, with the frequency increasing with age. This means no pain and full shoulder movement in the presence of a tear.   

People who have worked in jobs that require overhead activity, or who participate in overhead sports, may be more susceptible to tears. Sometimes the shoulder can gradually become painful due to a change in work, activity or because of increasing shoulder weakness. Smoking, inactivity and a poor diet have also been shown to contribute to an increased rate of rotator cuff tears, just as these factors can contribute to our overall aging process.  

So, keeping active is helpful for shoulder tendon health as well as the rest of the body. Simply going for a walk can be beneficial for your shoulder recovery. To improve shoulder strength, the right muscles often need to be reminded to work. Your physiotherapist can provide you with appropriate exercises to increase the resilience and strength of the shoulder, gradually helping to decrease pain over time. 

About the Author:

Sally McLaine is a Physiotherapist at Physiotas in Launceston.

Sally is an APA Sports Physiotherapist with a special interest in sports injuries and the shoulder. After studying and working in Melbourne, Sally moved to Tasmania and achieved the Sports Physiotherapy title in Perth, W.A. She is a member of Sports Medicine Australia and Shoulder & Elbow Physiotherapists of Australasia.

Sally is currently a PhD candidate at the University of Tasmania where she is investigating shoulder strength and pain in young swimmers. Working at the Sydney 2000 Olympics, Melbourne 2006 Commonwealth Games and with several sports teams has been among her career highlights.

Sally also has a passion for running and has completed (and enjoyed!) a marathon in every Australian state!