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Rotator Cuff Tears

Rotator cuff tears are characterized by pain with activity involving overhead motion. However, the patient is at times awakened at night with pain. The athlete with a chronic rotator cuff tear may experience a gradual loss of strength. Pain may be persistent, occurring even when the arm is at the side. 

Rotator cuff muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles.

Supraspinatus and infraspinatus muscle-tendon complexes are the most common tears.


This image shows a Rotator Cuff Tear
Rotator Cuff Tears

Symptoms

  • Pain location can be variable (anterior, lateral, or posterior shoulder).
  • Pain may radiate to elbow.
  • Pain typically is aggravated with reaching motions: laterally, toward the back and/or overhead
  • Nocturnal pain and pain on sleeping on the affected side are common.
  • Active range of shoulder motion is limited, and if the tear is severe, there will be atrophy of the shoulder muscles.
  • Manual muscle testing demonstrates weakness.
  • The Neer impingement sign is positive.

Clinical Findings

  • Diminished range of motion (ROM)
  • Pain with arm abduction, especially at 80–120 degrees of arc
  • Atrophy of cuff muscles, especially if chronic
  • Crepitus of supraspinatus muscle during abduction
  • Rotator cuff muscle weakness
  • Drop-arm test is positive for partial-thickness tear
  • Empty-can test is positive for large or full-thickness tears
  • Lift-off test for subscapularis is positive
  • Poor scapular stability is often present.
  • Anterior glenoid-humeral laxity may be noted.

Treatment

Acute treatment

Analgesia

  • NSAIDs are the drugs of choice initially (level II-2).
  • More potent analgesics may be necessary temporarily to relieve nocturnal symptoms.
Immobilization: Sling may provide some relief for the acutely injured shoulder.

Exercise Prescription

  • Most sports and activities are possible but secondary symptoms due to compensatory muscle activation are common and must be addressed.
  • Running and swimming are usually difficult but warm water can be helpful to release the shoulder.
  • The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular control.