What is Rotator Cuff Tear

Rotator cuff tear is a partial or complete tear of the cord-like bands (tendons) that connect muscle to bone in the rotator cuff.

The rotator cuff is a group of muscles and tendons that surround the shoulder joint and keep the upper arm bone (humerus) in the shoulder socket.

The tear can occur suddenly (acute tear) or can develop over a long period of time (chronic tear).

What are the causes?

Acute tears may be caused by:

• A fall, especially on an outstretched arm.
• Lifting very heavy objects with a jerking motion.

Chronic tears may be caused by overuse of the muscles. This may happen in sports, physical work, or activities in which your arm repeatedly moves over your head.

What increases the risk?

This condition is more likely to occur in:

• Athletes and workers who frequently use their shoulder or reach over their heads. This may include activities such as:
  • Tennis.
  • Baseball and softball.
  • Swimming and rowing.
  • Weightlifting.
  • Construction work.
  • Painting.
• People who smoke.
• Older people who have arthritis or poor blood supply. These can make the muscles and tendons weaker.

What are the signs or symptoms?

Symptoms of this condition depend on the type and severity of the injury:

• An acute tear may include a sudden tearing feeling, followed by severe pain that goes from your upper shoulder, down your arm, and toward your elbow.
• A chronic tear includes a gradual weakness and decreased shoulder motion as the pain gets worse. The pain is usually worse at night.

Both types may have symptoms such as:

• Pain that spreads (radiates) from the shoulder to the upper arm.
• Swelling and tenderness in front of the shoulder.
• Decreased range of motion.
• Pain when:
  • Reaching, pulling, or lifting the arm above the head.
  • Lowering the arm from above the head.
• Not being able to raise your arm out to the side.
• Difficulty placing the arm behind your back.

How is this diagnosed?

This condition is diagnosed with a medical history and physical exam. Imaging tests may also be done, including:

• X-rays.
• MRI.
• Ultrasound.
• CT or MR arthrogram. During this test, a contrast material is injected into your shoulder and then images are taken.

How is this treated?

Treatment for this condition depends on the type and severity of the condition. In less severe cases, treatment may include:

• Rest. This may be done with a sling that holds the shoulder still (immobilization). Your health care provider may also recommend avoiding activities that involve lifting your arm over your head.
• Icing the shoulder.
• Anti-inflammatory medicines, such as aspirin or ibuprofen.
• Strengthening and stretching exercises. Your health care provider may recommend specific exercises to improve your range of motion and strengthen your shoulder.

In more severe cases, treatment may include:

• Physical therapy.
• Steroid injections.
• Surgery.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • If you have a removable sling, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Raise (elevate) the injured area above the level of your heart while you are lying down.
• Find a comfortable sleeping position or sleep on a recliner, if available.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Once the swelling has gone down, your health care provider may direct you to apply heat to relax the muscles. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Keep the sling clean.
• If the sling is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a sling on your arm.

Activity

• Rest your shoulder as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do any exercises or stretches as told by your health care provider.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain gets worse.
• You have new pain in your arm, hands, or fingers.
• Medicine does not help your pain.

Get help right away if:

• Your arm, hand, or fingers are numb or tingling.
• Your arm, hand, or fingers are swollen or painful or they turn white or blue.
• Your hand or fingers on your injured arm are colder than your other hand.

Summary

• A rotator cuff tear is a partial or complete tear of the cord-like bands (tendons) that connect muscle to bone in the rotator cuff.
• The tear can occur suddenly (acute tear) or can develop over a long period of time (chronic tear).
• Treatment generally includes rest, anti-inflammatory medicines, and icing. In some cases, physical therapy and steroid injections may be needed. In severe cases, surgery may be needed.

Rotator Cuff Tear Rehab After Surgery

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

1. Stand near a wall or a surface that you can hold onto for balance.
2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to keep your balance.
3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
4. Keep moving so your arm swings in the following directions, as told by your health care provider:
   1. Side to side.
   1. Forward and backward.
   1. In clockwise and counterclockwise circles.

Repeat __________ times, or for __________ seconds per direction. Complete this exercise __________ times a day.

Exercise B: Flexion, seated

1. Sit in a stable chair so your left / right forearm can rest on a flat surface. Your elbow should rest at a height that keeps your upper arm next to your body.
2. Keeping your shoulder relaxed, lean forward at the waist and let your hand slide forward. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Flexion, standing

1. Stand and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick down with your healthy arm to raise your left / right arm in front of your body, and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward your spine.
   1. Keep your left / right shoulder muscles relaxed.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Abduction, supine

1. Lie on your back and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. Push the stick to raise your left / right arm out to your side and then over your head. Use your other hand to help move the stick. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Shoulder flexion, active-assisted

1. Lie on your back. You may bend your knees for comfort.
2. Hold a broomstick, a cane, or a similar object so your hands are about shoulder-width apart. Your palms should face toward your feet.
3. Raise your left / right arm over your head and behind your head, toward the floor. Use your other hand to help you do this. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
4. Hold for __________ seconds.
5. Use the broomstick and your other arm to help you return your left / right arm to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: External rotation

1. Sit in a stable chair without armrests, or stand.
2. Tuck a soft object, such as a folded towel or a small ball, under your left / right upper arm.
3. Hold a broomstick, a cane, or a similar object so your palms face down, toward the floor. Bend your elbows to an “L” shape (90 degrees), and keep your hands about shoulder-width apart.
4. Straighten your healthy arm and push the broomstick across your body, toward your left / right side. Keep your left / right arm bent. This will rotate your left / right forearm away from your body.
5. Hold for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise G: Shoulder flexion, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall with your left / right side facing the wall.
2. Gently make a fist and place your left / right hand on the wall so the top of your fist touches the wall.
3. With your left / right elbow straight, gently press the top of your fist into the wall. Gradually increase the pressure until you are pressing as hard as you can without shrugging your shoulder.
4. Hold for __________ seconds.
5. Slowly release the tension and relax your muscles completely before you repeat the exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Shoulder abduction, isometric

1. Stand or sit about 4–6 inches (10–15 cm) away from a wall with your right/left side facing the wall.
2. Bend your left / right elbow and gently press your elbow into the wall as if you are trying to move your arm out to your side. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder.
3. Hold for __________ seconds.
4. Slowly release the tension and relax your muscles completely before repeating the exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise I: Internal rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the palm of your hand against the door frame. Only your palm should be touching the frame. Keep your upper arm at your side.
3. Gently press your hand into the door frame, as if you are trying to push your arm toward your abdomen. Do not let your wrist bend.
   1. Avoid shrugging your shoulder while you press your hand into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise J: External rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the back of your wrist against the door frame. Only the back of your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist against the door frame, as if you are trying to push your arm away from your abdomen.
   1. Avoid shrugging your shoulder while you press your wrist into the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you repeat the exercise.

Repeat __________ times. Complete this exercise __________ times a day.