Rotator cuff rupture/tear - advanced therapy program

Rotator cuff is a group of muscles and their respective tendons which surround the shoulder joint, ie. connect it to the humerus (upper arm bone). This group encompasses m. supraspinatus, m. infraspinatus, m. subscapularis and m. teres minor whose primary roles are to ensure abduction and rotation of the arm in the shoulder and provide active stabilization and control for the joint.

The supraspinatus tendon is injured most often out of the group of tendons due to its specific position, situated between two bones and the excesive friction causes degenerative changes on the tendon which can lead to tearing or ruptures. Rotator cuff is commonly injured or damaged during activities where the arm  is oftenly lifted above shoulder level which causes excesive loading of the tendon tissue, eg. in swimming, waterpolo, handball, tennis, with construction workers, painters, etc. These injuries can be acute or chronic, acute injuries occur when a direct force affects the shoulder and it is too big for the tendons and muscles to handle it so they get injured or damaged (falls directly on the shoulder, forcefull and explosive shoulder movement under loads). Chronic rotator cuff injuries are a result of accumulated microdamages caused by overloading of the joint during an extended period of time.

When the injury occurs an intense pain, swelling and hematoma develops, often in the lateral part of the upper arm near the shoulder joint, the arm feels weak, especially when lifted above shoulder level, with tendon ruptures patients are unable to perform arm/shoulder movements and with time shoulder and upper arm muscle atrophy develops. Chronic pain is more intense during night.

Types of rotator cuff injuries:

1. Tendon inflammation – tendinitis, bursitis

2.Rotator cuff strain

3. Damage to the rotatory cuff tendon tissue – partial or complete tear of the tendon

Injury treatment depends on its severity, with ruptures a surgical approach is needed and the tendon should be repaired as soon as possible after the injury occured so that the tendon tissue does not shorten which makes it more difficult to repair and rehabilitate. Strains and smaller partial ruptures require a conservative treatment approach, immobilisation i sput on the shoulder to let it heal and after the acute reaction to the injury is taken care of functional therapy should be implemented with the aim of regaining full shoulder range of motion, shoulder and upper arm muscle strenght and stability of the rotator cuff and the shoulder as a whole.

Prevention: proper strenghtening of all shoulder muscle groups, especially the rotator cuff muscles, securing optimal shoulder flexibility and mobility, proper performance technique arm movements above shoulder level, etc.