Massage therapy · Kitchener–WaterlooRotator Cuff Rupture

Degenerative cuff ruptures happen after many years of gradual wear to the rotator cuff tendon. In many cases the tendon starts by fraying, and as the damage progresses it can go on to tear completely (AAOS, n.d.a).

Traumatic ruptures are more sudden, and happen after a fall on the shoulder or an outstretched arm, or after lifting something too heavy with a jerking motion (AAOS, n.d.a).

Movement of the arm is usually weak and restricted, which can make it difficult to raise the arm above shoulder height (UHCW, 2020). The aim of treatment, whether rehabilitation or surgery, is to reduce pain and restore movement and strength (AAOS, n.d.a).

The supraspinatus sits above the spine of the shoulder blade, and attaches to the top of the arm bone (humerus) via a tendon. A rotator cuff rupture most commonly relates to a full rupture of this tendon.

There is a lubricating sac known as the bursa that lies between the rotator cuff and the bone on the top of the shoulder (the acromion). The bursa allows the rotator cuff tendons to glide freely whenever you move your arm. When the tendons are damaged or injured, the bursa can also become painful and inflamed (AAOS, n.d.a). So it is not uncommon to have "subacromial bursitis" (inflammation of this bursa) with a rotator cuff tear.

The problem sits under the acromion, the bony point at the top of the shoulder blade. The acromion is joined to the collarbone at the AC joint (acromioclavicular joint), which sits next to the main ball and socket shoulder joint (AAOS, n.d.c).

1. Assessment

It's important to see a physical therapist or doctor to assess the damage. Sometimes it is not possible to tell whether the tendon is completely ruptured, and you may be referred for an ultrasound scan or MRI scan, which can confirm the diagnosis and help plan treatment (UHCW, 2020). If a rupture is found, a process of shared decision making will take place where you discuss (either with a consultant or a physiotherapist) the pros and drawbacks of rotator cuff repair surgery. As a general guide, when the tendon has torn because of a recent injury such as a fall, early surgical repair is normally recommended for people under 70; when it has torn through wear and tear, non-surgical treatment is normally tried first (UHCW, 2020).

2. Modification of Activities

Avoid any activities that cause pain in the shoulder (AAOS, n.d.a), especially sleeping on the affected side, and lifting your arm to the side or above your head.

3. Anti-Inflammatory Medication

AAOS OrthoInfo lists anti-inflammatory medicines, such as ibuprofen and naproxen, as a non-surgical treatment that can reduce the pain and swelling of a rotator cuff tear (AAOS, n.d.a). (This medicine information comes from AAOS OrthoInfo, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Options outside my scope

• Rotator cuff repair surgery: an operation, usually done by keyhole (arthroscopic) surgery, to reattach the torn tendon to the arm bone (UHCW, 2020). Recovery takes several months, and stiffness is a recognised complication afterwards (AAOS, n.d.b).
• Steroid injection: an injection of a local anaesthetic and a steroid (cortisone) to ease pain and inflammation. It does not work for everyone (AAOS, n.d.a), and it does not repair the torn tendon.

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