“The Doctor says I have a rotator cuff tear….What even is a rotator cuff? And what are my treatment options?”

Anatomy

-The rotator cuff is made up of 4 muscles; the infraspinatus, supraspinatus, subscapularis, and teres minor. Theses muscles originate on the scapula (shoulder blade), and cross the shoulder joint to attach on the humerus (upper arm bone). In a rotator cuff tear, it is the tendon (the white areas on the picture below) of one of these muscles that is typically injured. The supraspinatus tendon is the most commonly involved.

Image result for Rotator Cuff

Prevalence

-Age: In recent study by Hiroshi Minagawa et al, 664 volunteers underwent shoulder MRI’s and found that 22% of the population had full-thickness rotator cuff tears.

The prevalence of these tears was found to be related to age. Those in their 20’s-40’s had a 0% prevalence, 11% in the 50’s, 15% in the 60’s, 26.5% in the 70’s, and 37% in the 80’s. These numbers show that the older you are, the greater risk you are at to sustain a rotator cuff tear. About 1 in 3 adults over 60 will experience a rotator cuff tear at some point.

-Gender: Men have a significantly higher incidence in their 50’s and 60’s. However there is no gender differences in the 70’s and 80’s.

-Symptoms: However, if you get a tear, will you even know that you have one? This same study concluded that only 34.7% of the population who had a tear actually was experiencing any pain. This means that 65.3% of people with a confirmed tear on MRI had no symptoms. In other words, you are 2 times more likely to be asymptomatic after a rotator cuff tear than to experience symptoms.

 

Treatment

-Kukkonen et al recently published findings on rotator cuff treatment options in the Journal of Bone and Joint Surgery. They followed 160 individuals with full thickness supraspinatus tears. It is important to note that all patients had full functional range of motion in their shoulders. These patients were split into 3 groups. 1) Physical Therapy 2) Physical Therapy plus bone spur removal 3) Physical Therapy, bone spur removal, and rotator cuff repair.

-Patients were followed for up to 2 years and provided data on their symptoms, function, and patient satisfaction. They found that there were no significant differences between groups on patient satisfaction, symptoms, and function.

rotator cuff tear physical therapy versus surgeryboulder physical therapy shoulder surgery versus physical therapy

-Therefore, individuals with non-traumatic tears should strongly consider a 8-12 week course of Physical Therapy prior to any surgical intervention. Failure of conservative treatments like Physical Therapy, unrelenting night pain, and progressive loss of function warrants consultation with a shoulder surgeon.

 

References

Kukkonen J, Joukainen A, et al. Treatment of non-traumatic rotator cuff tears. A randomised controlled trial with one-year clinical results. Bone Joint J 2014;96-B:75-81

https://www.ncbi.nlm.nih.gov/pubmed/?term=Minagawa%20H%5BAuthor%5D&cauthor=true&cauthor_uid=24403741