Sunday, May 24, 2020

Rotator Cuff Injuries (tendinopathies/tears) by William Dao

NB: There are different types of injuries to the rotator cuff but this blog will refer to muscle tears and tendinopathies in particular.


What is the injury?

The rotator cuff is simply the name for a group of muscles and tendons in the shoulder. It is made up of 4 muscles:


  – Supraspinatus

  – Infraspinatus

  – Subscapularis

  – Teres minor


These muscles connect the ball of the upper arm bone (humerus) to the socket of the shoulder blade (scapula). They help provide strength and stability to the shoulder joint by centring the ball in the socket at rest and throughout movement.




Rotator cuff tendinopathy is the irritation or injury of the tendons in the rotator cuff muscles. The tendons are the fibrous connective tissues that connect muscle to bone. The term “tendinopathy” is used rather than “tendinitis” because most studies reveal little evidence of inflammation in these structures throughout the process. However, inflammation may potentially play a role in the initial phase of the injury. There may or may not be any weakness associated with a tendinopathy.

A rotator cuff tear is simply a partial or complete tear of one or more of the 4 muscles/tendons. Tears can have a sudden (acute) onset or a long-term (chronic) presentation. The Supraspinatus is the most commonly torn. You will often notice both pain and weakness with your shoulder in the presence of a tear. In severe cases, you may not be able to lift your arm at all.
Pain is often felt around the shoulder and the upper arm region.



How did I get this injury?


Repeated micro-trauma or overload is often the cause of rotator cuff tendinopathies as well as tears. Some examples are; throwing a ball, boxing, painting, lifting and washing a car for a longer than usual time or at a higher than usual intensity.
Note: a subacromial impingement Subacromial impingement could cause a rotator cuff tendinopathy or chronic tear of the rotator cuff muscles/tendons.



Acute tears of the rotator cuff can be caused from an injury or traumatic event. This can occur from a single event or it could occur from repeated micro-trauma. Chronic rotator cuff tears occur over time and are particularly common as people age. Up to 40% of people over 65 years of age will have degenerative tears of their rotator cuff muscle. Interestingly, not everyone will have pain and/or dysfunction.

Lifting of the arm itself, let alone lifting up weights could be painful. Chronic tears may or may not be painful, however, there may be a presence of a deep dull ache along with weakness. Sleep may be disrupted as laying on your back or on the affected shoulder may be painful.


How long will it take to fix?

Depending on the severity of the tendinopathy or tear of the rotator cuff muscles, time frames will vary. For a mild tendinopathy, you may return to usual sports and activities as early as 3-4 weeks with ideal management. However, as with most tendinopathies, load management is crucial and it could take 3-6 months to recover and, in some cases, up to 12 months.
For mild to moderate tears of the rotator cuff that do not require surgery, it may take 6 to 12 months. During the first 6 weeks you may have difficulty performing simple activities of daily living such as sleeping, brushing your teeth or hair, putting on or taking off your clothes, putting on and taking off your seat belt etc. Generally, between 6-12 weeks, you will see and feel some improvement but often you will not have returned to your pre-injury level of function. This will take time and perseverance with your rehabilitation exercises.


What do I need to do to Fix it?

At first, it is important for your Physiotherapist to identify whether or not further investigations may be required (e.g. ultrasound or MRI scans). The area and size of the tear or injury, range of movement and activity limitation as well as the presenting function of the shoulder may determine whether Physiotherapy alone would be enough to fix the problem.

If a conservative or Physiotherapy approach is suitable then the initial management will be focused on reducing pain and muscle tension. This can include; taping, soft tissue release techniques and dry needling to reduce the overactive muscles. We will also look at the neck and thoracic spine function to allow the shoulder and shoulder blade to work at its optimum. We will prescribe basic exercises to help with shoulder blade setting and control, postural correction, thoracic spine mobility and shoulder range of motion. We will then look at strength and general shoulder control with a gradual return to your pre-injury sports or physical activity. For a safe return to sport, we will need to ensure we have incorporated high speed, power, agility and proprioceptive type exercises to your rehabilitation program.



In certain cases, injections or surgery may be indicated, especially large rotator cuff tears or when Physiotherapy has been unsuccessful. For large acute tears of the rotator cuff muscles, that require surgery, it is crucial that it is not left unattended and you must avoid the “wait and see” approach as waiting for too long can lead to a poor surgical outcome. Nonetheless, if a rotator cuff repair is required, post-operative Physiotherapy is still essential for a full recovery. So, if you think you have a rotator cuff injury and want it fixed. Exercise prescription would be specific to your type and level of injury. There are no one-size-fits-all exercises for this issue. Therefore, if you think you may have injured your rotator cuff, please reach out sooner rather than later!


If you have any further questions on Rotator cuff injuries or any of our other blogs then please email us at or come and see us at Fix Physio Sydney in Sydney CBD