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Shoulder pain secondary to rotator cuff tear

The rotator cuff refers to a group of four small muscles which run from the shoulder blade to the top of the arm bone, (the supraspinatus, infraspinatus, teres minor and subscapularis). They act to both stabilise and move the shoulder joint. A rotator cuff strain refers to a tear in one or more of these muscles.




How does a rotator cuff tear occur?

A rotator cuff muscle may be strained or torn when it is forcibly contracted or overstretched. This can occur in any activity which requires movement of the shoulder.

How does it feel?

A tear of a rotator cuff muscle is usually felt as sudden pain or a ‘twinge’ felt in the shoulder area. In minor tears you may be able to continue the activity with minimal hindrance. However, as the muscle cools down following participation the pain may gradually worsen as bleeding and swelling around the injured muscle takes place. In more severe tears, pain may be exaggerated such that you are unable to continue participating immediately following injury. In these cases the shoulder may have restricted movement, weakness, and pain.

What should you do?

If you have or suspect you have a rotator cuff strain, it is advised you cease the activity and begin initial treatment. The most important time in the treatment of a rotator cuff strain is the first 24-48 hours. This is when bleeding and swelling around the injured muscle is most active. Although swelling is a necessary step in the healing process, too much can delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage, the injured rotator cuff muscle should be rested and iced. Rest involves ceasing activity or sport and limiting the use of the injured arm. Ice should be applied to the injured site for 15-20 minutes every 1-2 hours. Ideally, you should use crushed ice wrapped in a moist cloth or towel. You should continue this until you consult a physiotherapist. This should be undertaken as soon as possible following the injury.

What shouldn’t you do?

In the first few days following rotator cuff strain you shouldn’t undertake activities which increase blood flow to the injured muscle. These include:

  • hot showers
  • aggressive shoulder stretching
  • heat rubs
  • excessive use of the arm
  • heavy lifting

These can prolong muscle bleeding and exaggerate swelling resulting in further pain and an extended recovery.

Could there be any long-term effects?

Most rotator cuff strains heal without complication within a matter of weeks. However, a proportion of injuries can result in longer-term effects, depending on the severity of the injury and the extent of damage. For example, when a rotator cuff muscle is completely torn surgery may be required to repair the muscle. To recover from surgery and enable the muscle to fully heal, a extensive rehabilitation program is required.

Similarly, in minor tears recovery may be prolonged if the tear is not appropriately managed. This may result in a tight, weak rotator cuff muscle which is prone to re-injury with return to normal activity. This weakened muscle may also predispose you to other shoulder injuries such as rotator cuff tendinopathy (chronic non-inflammatory degeneration of the rotator cuff tendon).

Management of rotator cuff tear

The assistance of a physiotherapist is important in the treatment of a rotator cuff strain. Initially, they can assist in determining the exact tissue/s damaged and the extent of this damage. Imaging techniques such as ultrasound may be required to aid in the diagnosis. From this, your physiotherapist can determine how long the injury is expected to take to heal and develop an appropriate treatment plan. This may involve activity modification, the use of soft tissue treatment such as massage and stretching, and the progression through a series of specific strengthening exercises. Your physiotherapist will develop a series of exercises that will facilitate your return to normal activities, help prevent re-injury and reduce the likelihood of developing longer-term effects.

Gold Coast Physiotherapy and Allied Health at Burleigh Heads and Broadbeach  07 5535 5218


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