Rotator cuff tears are a problem that affect many people. Rotator cuff tears can be quite painful and often result in reduced shoulder function. While injuries to the rotator cuff can and often do build over time, frequently there is an event that triggers a sudden tear to occur.
The rotator cuff is a group of muscles that stabilize and allow for shoulder motion. The rotator cuff consists of the supraspinatus at the upper part of the scapula, the infraspinatus at the lower part of the scapula, the subscapularis between the scapula and the ribcage, and the teres minor from the scapula to the shoulder. A tear in any of these muscles constitutes a rotator cuff tear.
The rotator cuff is very important as it contributes to many shoulder motions. One of the contributing factors to rotator cuff problems is that portions of the rotator cuff are more active when the body is in the weak head-forward, shoulders-protracted posture that many adopt when sitting or using the computer. This position particularly increases activity of the supraspinatus, as the supraspinatus works to stabilizes the shoulder when the upper back and shoulders are elevated and protracted forward.
Another factor that places the rotator cuff muscles at increased risk of tear compared to other muscle groups is that the muscles of the rotator cuff are relatively small for the job they do. Additionally, the rotator cuff has a lot of leverage applied against it with the shoulder and arm acting as a long lever.
The supraspinatus muscle is particularly vulnerable to problems as it passes through the subacromial space, a bony tunnel-like structure produced by the border of the acromion. Chronic tightness of the supraspinatus as well as bony changes to the acromion can lead to impingement or bony pressure applied to the supraspinatus tendon as it passes under the acromion. Repetitive stress, pressure, wear, and inflammation on the supraspinatus tendon can lead to increased chances of supraspinatus tears.
Rotator cuff tears result in pain and weakness with motions that the torn muscle provides. With the supraspinatus for instance, this can result in pain and weakness when reaching above as well as above and behind the shoulder. Sometimes, full tears of muscles have milder pain or are even pain-free, but with the muscle fully torn it is unable to contribute to the motion it previously provided. This can be seen as reduced or altered movement patterns as well as weakness. Fully torn muscles cannot be reattached without surgical intervention, but conservative care can still be a good option for many cases.
Rotator cuff tears can be caused by traumatic injuries such as an auto accident. Forces applied to the body in an auto accident are sudden and can come from a variety of directions depending on the number and direction of impacts. Restraints such as the shoulder belt and grip on the steering wheel can direct significant force through the shoulder, potentially tearing tissues including muscles of the rotator cuff. Auto accidents injure many structures throughout the body, and pain can easily blend together, making it difficult to localize the pain of a tear to the rotator cuff. Pain and weakness from a traumatic rotator cuff tear often build and increases with inflammation over the first few weeks after an injury, further complicating diagnosis.
There are a variety of treatment options available for rotator cuff tears. Conservative treatment may include ice, exercise, stretches, massage, and range of motion exercises to decrease inflammation and rehabilitate the muscle. It is important to seek treatment for rotator cuff tears as scar tissue produced during the healing process can easily lead to adhesions, chronic pain, and decreased range of motion.
Sometimes surgical treatment is necessary for a rotator cuff tear. However, the cost to benefits of surgical intervention need to be carefully weighed. Rotator cuff surgical repairs are major procedures, and although surgical options have significantly improved in recent years, recovery and rehabilitation after a rotator cuff repair still takes months. Muscles may atrophy due to limited mobility and use during recovery from a surgical rotator cuff repair. In older patients, the extended recovery time for a surgical rotator cuff repair may lead to excessive atrophy of the other shoulder muscles, increasing the chances of further tears. For this reason, many patients opt for conservative treatment of rotator cuff tears even in the case of a full tear where function of the torn muscle would not be expected to return.
Chiropractors are well positioned to diagnose and provide conservative treatment for rotator cuff tears. Your Chiropractor will be able to advise you in exercises and stretches that are appropriate for each stage of healing, as well as provide manipulation and massage to maintain range of motion as you heal. Contact your Chiropractor if you are suffering from a rotator cuff tear whether from an injury or an auto accident.