Large Rotator Cuff Tear
What is it?
The Rotator Cuff is the name given to the set of muscles and tendons that all have to work together to stabilise the shoulder through movement.
Rotator cuff muscles and tendons back view of right shoulder
Rotator cuff muscles and tendons front view of right shoulder
Rotator cuff tears are common findings even in pain free shoulders. They are reported on ultrasound scans. Rotator cuff tears can occur as a result of prolonged overuse, age related change, trauma, or even surgery.
This section of the website is looking at large rotator cuff tears. This may cause you pain and mean you are no longer able to easily lift your arm. The deltoid is a powerful muscle on the outside of your arm that can be re-educated to compensate for the rotator cuff.
How Much Should I Push My Exercises
Pain during your exercise
Aim to keep your pain under 5/10 during exercise. If your pain is over this, then you can modify the exercises by either reducing the amount of movement during an exercise, reducing the number of repetitions, reducing the weights, reducing your speed or increasing how long you rest between sets.
Pain after Exercise
Your pain or other symptoms should return to your pre exercise baseline within 30 minutes of exercising. You should not feel an increase in your pain or stiffness the next morning. Although, sometimes it is normal to feel some muscle soreness from doing exercise that you have not been used to.
Rotator Cuff Strengthening Exercises:
There are numerous rotator cuff strengthening exercises available online. The trick is to use the correct exercises at the correct time. That is why its always best to get assessed by a Physiotherapist before you attempt any exercises. You may be doing the wrong exercise or an inappropriate exercise, depending on the severity of the injury. You can book online for an appointment or send us an email if you have any questions.
The below are examples of rotator cuff exercises. These could be attempted at various stages through the rehab program, as guided by your Physiotherapist.
External Rotation In 30 60 Flexion
- Upwardly rotate shoulder blade
- Thumb up grip on walking stick
- Keep elbows bent to 90º and elevate shoulders to 30 to 60º forward flexion
- Gently pull out involved arm while resisting with unaffected arm. There should be no arm movement.
- Work at 30% maximal voluntary contraction or at 3/10 effort
- This exercise can also be repeated using a light resistance yellow tubing or band.
What Is Rotator Cuff Related Shoulder Pain
Rotator cuff problems are one of the most common causes of shoulder pain, and is often experienced when lifting your arm away from your body, or by lying on your side in bed. You may be familiar with terms such as bursitis, tendinitis and impingement, however your shoulder pain is often due to a combination of factors. Therefore, the term “rotator cuff related shoulder pain” is a more accurate way to describe a number of different issues which could include tears in the muscle or tendon, inflammation and muscle weakness.
Other Stretches That Can Help
As you start to make progress with your rotator cuff injury exercises and the initial injury begins to heal, you can start adding in some more challenging stretching exercises. But don’t start too soon – you need to give the shoulder time to heal so you may need to wait 6-8 weeks after a rotator cuff injury before you start trying some of these stretches:
- Shoulder & Arm Stretches: for the rotator cuff, biceps & triceps muscles
- Trapezius Stretches: for the upper, middle and lower traps
- Upper Back Stretches: reduce pain and stiffness in the upper back
Symptoms Of Shoulder Impingement
Shoulder impingement can start suddenly or come on gradually.
- pain in the top and outer side of your shoulder
- pain that’s worse when you lift your arm, especially when you lift it above your head
- pain or aching at night, which can affect your sleep
- weakness in your arm
Your shoulder will not usually be stiff. If it is, you might have a frozen shoulder instead.
Read about other causes of shoulder pain.
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What Are The Common Symptoms
Pain occurs in and around the shoulder joint and can spread down the top of the arm. If there has been an injury, the pain may come on suddenly. Pain is usually worse when you use your arm for activities above your shoulder level. This means that combing your hair or trying to dress yourself can be painful but writing and typing may produce little in the way of pain. Pain may also be worse at night and affect sleep.
Occasionally your arm may also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching.
Factors that may contribute to rotator cuff related shoulder pain:
You may be told you have impingement from your GP or physiotherapist or after having an ultrasound scan, this is another term to describe subacromial pain or rotator cuff related shoulder pain.
Rotator cuff tendons
The rotator cuff works together to hold the ball on the socket during movement of the arm. If one or more of the tendons are weak they will not be able to do their job properly. Pain may start due to an overload of the tendons this can lead to some weakness. Age related changes in the tendon can also have an effect on the strength. The good news is exercises can help the tendon strengthen and reduce pain.
Stiffness of the shoulder
If the shoulder is stiff, the mechanics of movement and the way the tendons work to support the joint will be changed. This is why continuing to move the joint as pain allows is so important.
Section : Exercises For Stiff And Painful Shoulders
The main aim of exercise in the treatment of a painful and stiff shoulder is to reduce pain and improve the range of motion. The exercises below are examples of how you can achieve this. The exercise are split into 3 levels of difficulty.
You may find that these exercises slightly increase your symptoms initially. However you should find that the exercises themselves will become easier to do.
If the exercises do cause some discomfort then taking prescribed medication from your GP or pharmacist may help you to continue to exercise.
There is no recipe for what exercises you should do for a stiff and painful shoulder so feel free to try out the examples and find the ones that you feel help you the most. The exercises have been split up into active movement exercises , strengthening exercises and capsular stretches .
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Progressing Rotator Cuff Injury Exercises
After a couple of weeks, you should be ready to start some more challenging exercises where you get the muscles to initiate the movement, rather that following it so as to gain more strength and movement at the shoulder. So when you feel ready, check out these:
How To Manage It
The aims of treatment are pain relief to improve range of motion reduce duration of symptoms and return to normal activities. One or more of the following may help ease your symptoms.
Investigations are not usually required as it can be diagnosed easily from an examination and assessment of your symptom, it will often get better with time following education and exercise.
These are commonly advised with the aim of regaining movement in your shoulder and decreasing pain. For most benefit, it is important to do the exercises regularly and they should be comfortable to perform. Please give the following exercises a try and see if it helps with the management of your shoulder condition.
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How To Exercise Safely
Rotator cuff injury exercises are a really important part of rotator cuff tear treatment, but they should be performed carefully to ensure no further damage is done, particularly with a rotator cuff tear. Any new incidence of shoulder pain that doesnt settle within a few days should be evaluated by doctor who may advise a course of physical therapy.
The exercises here are typical rotator cuff physical therapy exercises and it is important to get a physical therapist to check you are performing them correctly.
It is important not to push in to pain with rotator cuff injury exercises, particularly in the early stages as this can cause more damage to the tendons. As the rotator cuff injury heals, you will be able to begin gently nudging into the pain in order to stretch out any areas of tightness and to improve muscle strength, but any pain should subside within around 30 minutes of stopping rotator cuff injury exercises. If you are still noticing ill-effects a couple of hours later, you most likely overdid things so reduce the number of repetitions, or the amount of resistance used.
Best Rotator Cuff Injury Exercises
Rotator cuff injury exercises will vary depending on what stage of rehab you are at. In the early days after a rotator cuff tear, the focus should be on controlling the pain and keeping the shoulder loose.
Here we will start with rotator cuff injury exercises that are suitable in the early stages of rehab, which you will find in three groups
As the torn rotator cuff heals, you can move the shoulder through a greater range and start to do some more challenging shoulder rehab exercises.
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The Best Way To Treat Rotator Cuff Tendonitis The Most Common Cause Of Shoulder Pain Is With Simple Home Therapies
Swinging a tennis racket, digging in the garden, placing a book on a high shelf, and reaching back to insert your arm into a sleeve these are some of the movements made possible by the shoulder’s enormous range of motion. We use this mobility in so many activities that when the shoulder hurts, it can be disabling. For younger people, sports injuries are the main source of trouble, but the rest of us have more to fear from the normal wear and tear that, over time, weakens shoulder tissues and leaves them vulnerable to injury. The risk is greatest for people with occupations or hobbies that require repetitive or overhead movements, such as carpenters, painting, tennis, or baseball.
The most common cause of shoulder pain is rotator cuff tendonitis inflammation of key tendons in the shoulder. The earliest symptom is a dull ache around the outside tip of the shoulder that gets worse when you push, pull, reach overhead, or lift your arm up to the side. Lying on the affected shoulder also hurts, and the pain may wake you at night, especially if you roll onto that shoulder. Even getting dressed can be a trial. Eventually, the pain may become more severe and extend over the entire shoulder.
When severe, tendonitis can lead to the fraying or tearing of tendon tissue. Fortunately, rotator cuff tendonitis and even tears can usually be treated without surgery.
Is Pt For Me
If you think you have a tear, see your doctor. They may send you to someone who treats bones, joints, muscles, and tendons, called an orthopedic doctor. They can talk to you about surgical and nonsurgical options, including PT.
Unless the injury is severe, PT is a typical starting point. Your physical therapist will ask questions about your life and the things you do. Theyâll do some tests to learn more about your pain. The therapist will ask you to raise your arm, move it to the side, or push against something to see what your limits are.
PT helps in lots of ways. One study shows that people who got PT for a rotator cuff tear did just as well as those who had surgery.
The therapist will help you:
- Get back your range of motion
- Learn exercises to strengthen your shoulder muscles
- Improve the way you sit and stand to help reduce pain
- Find a way to sleep that doesnât hurt your shoulder
- Learn to carry objects safely
- Use ice or heat to ease the pain
- Understand why you need to keep moving
- Find ways to do things so that they donât hurt your shoulder
- Return to your regular activities
PT can also help you recover after rotator cuff surgery. Itâs the same idea — to improve strength and movement and get back to regular life. The therapist will show you how not to injure your shoulder again after surgery.
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Can You Exercise With A Rotator Cuff Tear
Lets start with the basics: A partial or complete tear of a rotator cuff muscle can make it difficult to just raise or move your arm. Expect to feel a general weakness in your joint. Your range of motion may be less than ideal, too.
But that doesnt mean workouts are a definite no-go. Two key factors determine how much youll be able to do after injuring your rotator cuff the severity of your injury and your ability to tolerate pain.
Some people can exercise with a tear and some people cant, says Kinsey. Thats the truth of it. There isnt just one answer.
The good news? Converting that bum shoulder into a healthier wing to keep your fitness routine on track is very doable. Roughly 8 out of 10 people with partial rotator cuff tears get better using options like:
- Rest to give your overused shoulder much-needed downtime.
- Nonsteroidal anti-inflammatory drugs to limit pain and swelling.
- Steroid injections to ease pain and swelling.
- Physical therapy for rebuilding range of motion and strength.
Over a month or two, particularly with physical therapy, people are often able to get back to where they feel comfortable, says Kinsey. Its a slow and gradual process.
Heres where that PT process often begins.
How Can I Relieve Rotator Cuff Pain At Night
The best way is to contact us for a tailored treatment plan for a quick recovery. Avoid lying on your painful side in bed and stop doing the activities that aggravate it in your day-to-day life. Speak with your GP or Pharmacist for suitable pain relief. This is helpful in the early acute stages of a rehabilitation program to get the pain under control. There is a lot of research linking a good nights sleep to faster recovery rates after an injury.
The rotator cuff is a versatile and important group of muscles in the shoulder joint. Weekly strengthening and neuromuscular exercises would be advisable. Particularly for anyone who needs to do repetitive overhead tasks at work or throwing activities for sport/hobbies. To find out the best exercises for a rotator cuff injury contact us now for a physiotherapy appointment. Alternatively, please book directly online. You can also book in with us for an rotator cuff injury prevention programme also.
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Exercises To Avoid With An Injured Rotator Cuff
If youre a fitness buff trying to work through your rotator cuff issues at the gym with free weights, youll quickly learn to avoid lifting anything straight over your head. .
But a few lifts that put added strain on your bad shoulder might surprise you. The list includes:
- Deadlifts. These heavy weights are basically pulling your arm out of your socket, says Kinsey. Its a lot of tension on the rotator cuff.
- Shrugs. Another example of weight pulling down on your shoulder.
- Squatting. Resting the bar across your shoulders and your arm positioning stresses the rotator cuff.
If you truly cant stay away from the gym, Kinsey offers this advice: Work your legs. Focus on a different area for a little bit, she says. Just give your shoulders a break.
Rotator Cuff Injury Exercises
Rotator cuff injury exercises aim to restore strength and flexibility to the shoulder. The rotator cuff is a group of four muscles that surround the shoulder joint, like a cuff, and work together to move and stabilise the shoulder.
The two most common types of rotator cuff injury are:
- Tendonitis: where one of the rotator cuff tendons get inflamed
- Rotator Cuff Tear: where one of the tendons gets torn due to overuse or injury.
Both problems cause pain, weakness and stiffness in the shoulder, and rotator cuff injury exercises are vital to restore normal movement, strength and function.
In most cases, you can start rotator cuff injury exercises as soon as pain allows, but you should always consult your doctor or physical therapist first to check that the exercises are suitable and whether any further treatment is required.
How much you are able to do with a rotator cuff injury will depend on:
- the severity of the injury
- the severity of your symptoms – this doesnt always correspond with the amount of injury
- how long it has been since your injury
- how restricted your strength and movement is
Related Article:Rotator Cuff Muscles – Anatomy & Function
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Arm Swings: Forward And Back
Before starting this exercise, find out:
You should do this exercise lying on your side. A good place to do this exercise is on your bed.
Lifting the weight up and down in one repetition.
|Lie on your right side with a cushion to support your neck. Your left arm should be bent at a right angle out in front of your body. You can place a light weight in your left hand if you like.
|Keeping your arm bent and a right angle, lift your hand so that it points towards the ceiling.
|Gently bring your arm back to the starting position.
If you prefer, you can to refer to while doing them.