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Rotator Cuff Breakdown

By Chris Gelllert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM

Background:

Rotator cuff tears come in all shapes and sizes. A small tear (<1cm) typically can heal typically without surgery and would benefit from physical therapy, addressing soft tissue restrictions, restoring functional mobility then stability. A medium tear (2-5cm) may or may not require surgery. Finally, a large or massive tear (5cm or >), will not respond to physical therapy and conservative treatment, requiring surgery followed with physical therapy.

Therefore, understanding the location and type of rotator cuff tear will provide clarification regarding the client’s shoulder.

Most tears affect the supraspinatus muscle. Why? Beccause the supraspinatus is biomechanically weaker and has poor blood supply as compared the surrounding muscles.

Stage 1- Patients are usually 25 years old and have pain with activity that usually resolves with rest. The condition is reversible, and treatment is conservative.

Stage 2-Fibrosis and tendonitis. Patients are typically between 25-40 year old and experience recurrent pain with activity that does not always abate with rest. According to Neer MD, subacromila decompression should be considered if all other conservative treatment fails.

Stage 3-bone spur and tendon rupture. Patients are older than 40 year and have a history of progressive disability. Rotator cuff repair is advised.

Stage 4-Cuff tear arthopathy(disease of the joint). Patients are typically older than 60 years and have a history of progressive disability with a torn rotator cuff. Clinical management consists of a RTC repair, hemi-arthoplasty or total shoulder replacement.

Effective exercises: Based on evidenced based research and biomechanics, it is important to design a program that tailors to the need of post-rehabilitative client. Understanding the anatomy, biomechanics, forces, functional anatomy and exercise selection is paramount!

Teaching the client the following exercises is beneficial:

·     Mid row exercise targets the weaker phasic rhomboid muscles, helping unload the anterior shoulders and improving posture

·     Low trapezius pulldowns targets the weaker phasic low trapezius.

·     External rotation with cable exercise targets the weaker infraspinatus and teres minor muscles(see picture)

·     Pullaparts with tubing targets the posterior deltoid.

Exercises that are contraindicated include with rationale:

•      Seated dumbbell shoulder press (creates excessive load to the medial deltoid).

•      Lat pull downs behind the head (at end or range places greatest stress on all glenohumeral ligaments as well as on the labrum).

•      Upright row (at end of range-shoulder is maximally internally rotated which places stress on all glenohumeral ligaments, labrum and connective tissue).

 

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