Rotator Cuff

Tears:
cheat-sheet
Rotator Cuff Tears
Pathophysiology & Epidemiology
Rotator cuff tears (RCTs) occur when one or more of the rotator cuff tendons is torn. This can be an
acute or degenerative injury. The supraspinatus tendon is most commonly torn, however damage to the
subscapularis, infraspinatus and/or teres minor does occur. RCTs are defined as partial or complete (full-
thickness), depending on the degree of damage to the tendon. RCTs are common in overhead athletes
and the elderly, with a general consensus that conservative management is superior to surgical repair in
most cases. Complete RCTs in young athletes often require surgical repair however this is still a debated
topic. Atraumatic degenerative RCTs are part of the ageing process, affecting approximately 40% of the
population who are >60 years of age. Highlighting their prevalence, the occurrence of asymptomatic
partial or complete RCTs is reported to be 8-46% of the population, significantly increasing with age.

Causes
Acute:
- Can occur with a fall on an outstretched arm or lifting a heavy object
- Can occur with other shoulder trauma e.g. dislocation, clavicle fracture etc
Degenerative:
- Repetitive stress over time e.g. overhead sport, overhead occupations like cleaning, painting etc
- Bony spurs, lack of blood supply, Hx of trauma, >40 y.o. M>F, smoking, high BMI

Clinical Presentation Differential Diagnosis & Red Flags

- Pain: at rest, at night when lying on affected - Cervical spine radiculopathy
shoulder, when lifting/moving arm, often located - Acromioclavicular injury
anterolaterally and superiorly - Subacromial impingement
- Decreased ROM: flexion, ER and abduction - OA, RA
- Decreased strength: in any shoulder movements - Myocardial infarction, angina pectoris
- Difficulty with ADLs: mainly overhead i.e. reaching - #, tumour, night pain, infection,
in cupboards, brushing hair, reaching behind etc inflammatory disease
- Clicking, instability and/or crepitus - Shoulder instability
- Atrophy of rotator cuff muscles may occur - Brachial plexus injury

Diagnosis
- Based on presentation: weakness, PROM is significantly greater than AROM, tender on palpation,
atrophy, decreased strength, stiffness etc
- Special tests (poor validity): full/empty can test, drop-arm test, subacromial grind test
- Scans: X-ray (measures size of subacromial space, highlight bony spurs, rule out #), MRI (shows
complete or partial tear, inflammation, and capsule), CT scan and Ultrasound can also be used

Acute Management Ongoing Management

- Pain management: NSAIDs, heat, ice,
massage, etc
- Gentle stretching: crossover arm stretch,
doorway stretch etc
- Improve ROM: pendulum swings, active-
assisted ROM, table slides etc
- Improve strength: start slow and build up,
semi-closed chain exercises with increasing
impact and resistance, shoulder balance
exercises in increasing elevation
- Psychosocial support: always important ++
- Progress ROM exercises
- Progress strengthening exercises: ensure
that they are task/sport specific and
incorporate S&C principles (the theraband
will only get them to a certain point… the
aim is for them to have a robust shoulder)
- Ongoing psychosocial support
- Corticosteroid injections can be indicated,
however their effectiveness varies greatly
- Consult with surgeon may be required if
little progress is made after many months

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