I recently coordinated continuing education on treatment of the shoulder for physical and occupational therapists at HealthReach Rehab. My final contribution to the courses was evidence-based treatment of rotator cuff tears. The rotator cuff is a group of four muscles at the shoulder, named supraspinatus, infraspinatus, teres minor, and subscapularis. The most commonly torn muscle is the supraspinatus. The main function of the rotator cuff is to add stability to one of the most unstable joints at the shoulder. Without the rotator cuff working properly, reaching overhead becomes more difficult and painful. Many times another condition called shoulder impingement and rotator cuff tendinitis can lead to a rotator cuff tear. As I was looking at the research in regard to rotator cuff tears I found some statistics that I thought some of you might find interesting.
- The United States spent $7 Billion in 2000 in healthcare costs to treat shoulder pain
- Rotator cuff tears increase in incidence after the age of 40 and up to 40% of the population over 60 years old has a full-thickness rotator cuff tear
- 78% of patients with rotator cuff tendinitis were treated successfully with non-operative treatments including a combination of medication and physical therapy
- 75% of those with a large rotator cuff tear retear the muscle after surgical repair
- 70% of full-thickness rotator cuff tears are expereinced in those that do light work and are relatively sedentary
The risk factors for rotator cuff tears and tendinitis:
- age-related degeneration
- muscle atrophy
- poor posture
- repetitive overuse
- shoulder impingement and rotator cuff tendinitis
- impaired shoulder mechanics
- anatomical variation of the shoulder
The research indicates those that do best after a rotator cuff surgery are patients that are relatively young and have an acute injury. In other words, don’t wait months and months to get treatment for this condition, because it may be too late to do surgery if you need it. If you think you may have done something to your shoulder and you are over 40, definitely schedule an appointment with your physical therapist or physician. If a rotator cuff tear is suspected, your physician may order a test to confirm the diagnosis. Research indicates that diagnostic ultrasound and MRI are the most effective and are equally effective at diagnosing rotator cuff tears. Diagnostic ultrasound is cheaper than MRI, but most physicians order an MRI because diagnostic ultrasound requires the technician to be highly trained and skilled. If you have to pay for this out-of-pocket and are concerned about the cost, ask your physician if they know where to send you for a diagnostic ultrasound.
One article mentioned a study of outcomes following surgical repair of rotator cuff tears. They found that satisfaction and function (improved flexibility, range of motion, and ability to reach overhead) improved even in the presence of a failed surgery! They attributed this in part to the fact that after a patient undergoes surgery they are much more committed and compliant with exercises to strenghten the rotator cuff and shoulder. The exercises are soooooo important! As a physical therapist, I see many people with shoulder pain including those with rotator cuff tendinitis, rotator cuff tears, and after surgery to repair a rotator cuff tear. This condition is extremely painful, but can be managed successfully in physical therapy with a combination of manual therapy and exercises. Physical therapy can help you overcome developing rotator cuff tears in almost all of the risk factors listed above. Wake up and smell the muscles! Be sure to pump up your shoulders with resistive exercise to keep them strong and prevent a painful condition, the rotator cuff tear.
1. Hemang Yadav, Shane Nho, Anthony Romeo, John D MacGillivray. Rotator Cuff Tears: Pathology and Repair. Knee Surgery, Sports Traumatology, Arthroscopy. Heidelberg:Apr 2009. Vol. 17, Iss. 4, p. 409-421
2. J Winslow Alford. Exploring treatment options for rotator cuff disorders. The Journal of Musculoskeletal Medicine. Darien:Mar 2009. Vol. 26, Iss. 3, p. 99-103 (5 pp.)
3. Boissonnault WG, Badke MB, Wooden MJ, Ekedahl S, Fly K. Patient Outcome Following Rehabilitation for Rotator Cuff Repair Surgery: The Impact of Selected Medical Comorbidities. JOSPT 2007; 37(6): 312-319.
4. Long JL, Ruberte Thiele RA, Skendzel JG, Jeon J, Hughes RE, Miller BS, Carpenter JE. Activation of the Shoulder Musculature During Pendulum Exercises and Light Activities. JOSPT 2010; 40(4): 230-237.