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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

  1. Supraspinatus tendon
  2. Infraspinatus tendon
  3. Teres minor tendon
  4. Teres minor muscle
  5. Infraspinatus muscle
  6. Supraspinatus muscle

Rotator cuff muscles and tendons – front view of right shoulder

  1. Subscapularis tendon
  2. Subscapularis muscle
  3. Supraspinatus muscle

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 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.

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Rest or activity modification 

This does not mean you stop moving or using your shoulder altogether. It means reducing activities over your head or behind your back as this can help to reduce the irritation of your shoulder.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

Exercises

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.

The following exercises are a 10 stage non-operative programme for the management of large rotator cuff tears. These are normally performed with the supervision of a physiotherapist either remotely or face to face. Click here to self-refer to a physiotherapist.

See below or for video instructions click here.

Exercises should be done two to three times a day to strengthen your deltoid muscle and gain full benefit. Aiming for 10 repetitions. These exercises must be done for at least 12 weeks and must always be performed starting lying down to begin with. Start at stage 1 and then progress to the next stage once this can be performed comfortably. On starting a new stage it is common to have some discomfort in the shoulder. It should not, however, cause severe pain or pain that affect you at night or the next day.

Stage 1:

Lying on your back with your arms by your side, bend your elbow on your affected side to 90 degrees, then lift the elbow off the bed towards the ceiling. When upper arm is vertical straighten your elbow. When you have lifted the arm as high as you can, slowly bend the elbow and return the arm to the bed, as controlled as possible.

Stage 2:

You will need a yellow resistance band. Lying on your back with your arms by your side, bend your elbows to right angles holding the resistance band. Take your hand on the affected side out to the side. Then control back to the middle.

Stage 3:

Start as if you were doing stage 1, once the arm is fully straight add a small swaying movement away from, and towards the head. When finished, bend the elbow and return the arm back to the bed in a slow and controlled manner.

Stage 4:

Repeat stage 3. Holding a bottle with a small amount of water to increase resistance.

Stage 5:

Activities in stages 1 – 4 repeated with head of bed progressively raised, as in the picture above.

Stage 6:

Stand facing a wall with a cloth in your affected hand. Keeping as much pressure through your hand, slide it up the wall. At the top, hold for a few seconds and try to increase stretch with unaffected side supporting. Lower arm back down keeping pressure through hand, in a slow and controlled manner.

Stage 7:

Sit down and bend your elbow of the affected arm so that the hand is close to the shoulder. Reach the arm up until the elbow is pointing towards the ceiling, then straighten the arm. Slowly reverse the movement and control the arm back down to your side.

Stage 8:

Repeat as Stage 7. Then lower your hand to touch your head and straighten your elbow again. Repeat 2-3 times before slowly lowering your arm back to your side keeping elbow bent.

Stage 9:

Sitting with your elbows bent and in to your sides holding a yellow resistance band. Take the affected side away from your body as far as you are able. Slowly return to the starting position as controlled as possible.

Stage 10:

In 4 point kneeling transferring weight forwards and backwards.

In 4 point kneeling transferring weight side to side

In 4 point kneeling progress by either lifting a leg or an arm. Remember to keep your back still.

Physiotherapy 

As mentioned above and in the video. This programme is normally supervised by a physiotherapist either remotely or face to face. Click here to self-refer to a physiotherapist.

How to prevent and manage future symptoms? 

As with all MSK conditions try to keep active with regular exercise. Try to follow the advice above and keeping a routine of daily activity. Whenever doing more, whether that is gardening or weight training, remember to gradually build up your loading of the shoulder. If performing repetitive overhead tasks, make sure you are taking breaks and changing position regularly. 

If you are having difficulty managing your shoulder pain or having difficulty returning to your usual activities, please refer yourself to a physiotherapist.

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