Understanding Rotator Cuff Tears

Rotator cuff tears are a common cause of shoulder pain and discomfort, affecting millions of people worldwide, and in Australia alone, it is estimated that over 700,000 people suffer from a rotator cuff tear. The rotator cuff is a group of muscles and tendons that attach the upper arm bone to the shoulder blade and provide stability to the shoulder joint. A rotator cuff tear can be caused by injury, overuse, or aging, and can range from mild to severe.

What is the rotator cuff?

The rotator cuff is a group of four muscles in the shoulder: Supraspinatus, Subscapularis, Infraspinatus, and Teres minor. These muscles work around your shoulder blade and humerus to provide stability to your shoulder joint as you move — think of them as the "core muscles" of your shoulder. They allow the larger, more familiar muscles around your shoulder (deltoid, pecs, lats) to move the arm powerfully and in a controlled manner, with the rotator cuff assisting to control and support that movement. Because they are such important muscles, they are also prone to injury.

What causes rotator cuff tears?

• Impact or direct trauma — an injury involving a fall or a sporting injury, usually involving an impact
• Overuse — continued repetitive movements, usually overhead, that can cause breakdown of the tissue or tearing over time (e.g. repetitive lifting or painting a ceiling)
• Aging — as we age, the rotator cuff tendons can become weaker, brittle, and more susceptible to injury

Symptoms of a rotator cuff tear

Symptoms vary depending on the severity of the injury, and commonly include pain in the shoulder (especially when lifting or reaching overhead), weakness in the shoulder, stiffness, and a crackling sensation when moving the shoulder.

Diagnosis and treatment

If you suspect a rotator cuff tear, it's important to see a physiotherapist. They can perform tests to identify which tissue is damaged and provide an individualised treatment plan, and can refer you directly for an X-ray or MRI if needed. Treatment options may include hands-on manual therapy, taping to unload the injured tissue, cryotherapy (such as a Game Ready unit), a progressive strengthening program, and education on activity modification with a home therapy program. In more severe cases, surgery may be necessary, and your physio can help with planning and selecting a suitable surgeon.

Tips for preventing rotator cuff tears

• Strengthen the rotator cuff — targeted exercises help strengthen the tendons and reduce your risk of injury
• Avoid repetitive overhead movements — if you play sport or do manual labour, try to limit repetitive overhead strain
• Maintain good posture — poor posture can lead to shoulder strain and increase your risk of injury

Rotator cuff tears are a common cause of shoulder pain and discomfort. While they can be difficult to prevent entirely, strengthening the rotator cuff, avoiding repetitive overhead movements, and maintaining good posture can all reduce your risk. If you suspect a rotator cuff tear, book an assessment with one of our physiotherapists for proper diagnosis and treatment.