There are many ways the rotator cuff musculature is injured: overload, wear and tear, acute trauma just to name a few. How do you know if you’ve injured your rotator cuff? And more importantly what is the right management for rotator cuff injury? Will you benefit from shoulder physiotherapy?

Let’s take a step back and start with the basics: what is the rotator cuff?
The rotator cuff is a group of four muscles in your shoulder joint which are the dynamic stabilisers of your humeral head (the ball) in the socket. To break it down, the rotator cuff’s function is to keep the ball in the socket when we move our arm. They work closely with the ligaments in our shoulder to keep the ball (humeral head) centred in the socket (glenoid). The cuff muscles are a very important muscle group which allow us to reach above our head and move our upper arm without the humeral head moving around in the socket disrupting other structures. They are the main structure in the shoulder causing patients to seek shoulder physiotherapy.

How does rotator cuff injury occur?
Rotator cuff injuries occur in one of two ways – acute trauma or chronic overload. Commonly, chronic overload will occur with poor postures causing impingement of the rotator cuff tendons slowly fraying away at the tendon until symptoms of tendinopathy, partial tear or rupture occur over time. We know that other chronic illnesses such as heart disease, type 2 diabetes, high cholesterol and a lack of regular physical activity can all contribute to developing a painful rotator cuff. Conversely, rotator cuff injury can also occur with a rapid increase in overhead activity (repetitive lifting of bags above head on flights when travelling, painting a wall, beginning a throwing sport when it’s not something you commonly do) or trauma (falls, wrenching injury). This is an injury often first attended to by shoulder physiotherapy.

So who is likely to have a rotator cuff injury?
We see two groups of people who commonly injure their rotator cuff: throwing athletes and people over 40 years old. That is not to say that others can’t sustain a rotator cuff injury, these groups are just more at risk of this injury. Throwing athletes use their rotator cuff at a much higher frequency and thus are more at risk of injury. People over the age of 40 generally have increased risk of rotator cuff injury due to age related wear and tear of their tendons (Wolf et al, 2007). Middle-aged women can also have an increased risk of tendon injury due to the hormonal changes that occur around menopause which makes our tendons more susceptible to injury (Bytomski et al, 2006). If you have shoulder pain and fit into one of these categorises it may be worth seeing a shoulder physiotherapist.

How do I know if I have a rotator cuff injury?
Symptoms of rotator cuff injury include pain in or around the shoulder, commonly down into the outer arm but not past the elbow. Reduced ability or inability to lift your arm all the way up above your head. Weakness in your shoulder or a lack of endurance when performing overheard activities like hanging washing, blow-drying your hair or cleaning windows. An assessment with your shoulder physiotherapist to determine your exact diagnosis will confirm your rotator cuff injury.

When is a scan necessary?
A scan may be necessary for higher grade rotator cuff injuries or if your rotator cuff injury is not progressing with shoulder physiotherapy the way we expect it should. However, it is crucial to note that shoulder scans can be quite confusing and thus it is important to seek guidance from your shoulder physiotherapist about whether they believe your scan matches your clinical presentation. As we age it is normal for the rotator cuff tendons to wear and degrade, thus they become weak and prone to rupture/tear. This is the normal process of aging and as we use our shoulders every day for many of our activities of daily living, wear and tear will ultimately occur (just like if you wear the same pair of shoes everyday eventually they will wear out). Evidence has shown that 40% of people over the age of 40 years have a rotator cuff tear which is often non-symptomatic (Wolf et al, 2007).

How long do rotator cuff injuries take to heal?
Healing time is variable and is totally dependant on the type and grade of injury as well as individual factors such as compliance to restrictions and exercises, past history of injury and your current health status. A high-grade strain may take up to 16 weeks to heal where as a low-grade reactive tendinopathy may only take 4-6 weeks. After consultation with your shoulder physiotherapist you will have a much clearer picture of your prognosis (Osborne et al, 2016).

When is surgery likely to be beneficial for a rotator cuff injury?
Surgery is generally the last resort for rotator cuff injuries. In most cases, shoulder physiotherapy including a progressive strengthening program will be the best management for rotator cuff injury. However, there is a small percentage of patients who will benefit from rotator cuff repair. Generally, this population will have had an acute traumatic incident and have a high-grade strain. Your shoulder physiotherapist will be able to educate you on when surgery is likely to be beneficial and when your injury will be better managed conservatively with shoulder physiotherapy such as load management and progressive strengthening exercises (Wolf et al, 2007).

A thorough shoulder physiotherapy assessment and management plan in addition to compliance with your shoulder physiotherapists advice and exercises regime is crucial in the management of rotator cuff injury.

Wolf, B. R., Dunn, W. R., & Wright, R. W. (2007). Indications for Repair of Full-Thickness Rotator Cuff Tears. The American Journal of Sports Medicine, 35(6), 1007–1016. Bytomski JR, Black D. Conservative treatment of rotator cuff injuries. Journal of Surgical Orthopaedic Advances. 2006 ;15(3):126-131.

Osborne JD, Gowda AL, Wiater B, Wiater JM. Rotator cuff rehabilitation: current theories and practice. The Physician and Sportsmedicine. 2016 ;44(1):85-92. DOI: 10.1080/00913847.2016.1108883.