Rotator Cuff Injury

ROTATOR CUFF INJURIES

Rotator cuff injuries range from tendinopathy and partial tears to full-thickness tears. The physio goal is the same either way: reduce pain, restore motion, and rebuild strength/stability so the shoulder doesn’t keep irritating.

1. *Figure out what’s going on*

Physios check:

- *Pain pattern*: Lateral shoulder pain, worse with overhead/lifting, often painful at night. Weakness with abduction/external rotation.

- *Range vs strength*: Painful arc with active motion but full passive ROM = likely tendinopathy/tear. Loss of passive ROM = frozen shoulder component.

- *Mechanism*: Sudden lift/pull = acute tear. Gradual onset with repetitive overhead = tendinopathy.

- *Differential*: Rule out cervical referral, biceps tendinopathy, subacromial bursitis. MRI confirms tears but treatment is similar for partial tears.

2. *Acute phase: calm the irritation*

If lifting your arm hurts and you’re guarding:

- *Load modification*: Avoid painful overhead activity and heavy lifting. Don’t stop moving entirely - complete rest makes it worse.

- *Scapular setting*: Gentle scapular retraction/depression. A stable scapula takes load off the cuff.

- *Pain-free motion*: Pendulum exercises, active-assisted forward flexion within comfort. Keep the shoulder moving to prevent stiffness.

- *Manual therapy*: Soft tissue work on upper traps, pec minor, posterior capsule if tight. Joint mobilizations if glenohumeral joint is stiff.

3. *Strength and control phase*

This is where you rebuild the cuff’s ability to control the humeral head.

- *Rotator cuff strengthening*: Start with isometrics, then bands for external/internal rotation, scaption. Low load, high reps.

- *Scapular strengthening*: Serratus punches, lower trap activation, rows. 70% of cuff problems have scapular dysfunction underneath.

- *Eccentric control*: Slow lowering in abduction and external rotation. Eccentrics remodel tendon tissue better than concentrics.

- *Posture work*: Forward head/rounded shoulders increase impingement. Chin tucks, thoracic extensions.

4. *Functional phase*

Get you back to overhead work, lifting, sport.

- *Overhead progression*: Start with wall slides, progress to dumbbell overhead press only when pain-free.

- *Plyometrics*: Ball tosses, reactive catches for dynamic stability.

- *Sport/work-specific drills*: Throwing mechanics, swimming strokes, lifting technique. Break down the motion and rebuild it.

- *Load management*: Follow the 10% rule. Tendons hate sudden load spikes.

5. *Surgical vs conservative*

- *Partial tears and tendinopathy*: 80-90% improve with 3-6 months of targeted rehab. Surgery isn’t first line.

- *Full-thickness tears*: If you’re young, active, and have weakness/instability, surgery often gives better outcomes. Older, low demand, minimal symptoms = conservative rehab works well.

- *Massive tears*: Rehab focuses on pain control, motion, and strengthening deltoid/scapular muscles to compensate.

What actually works

Evidence shows *exercise therapy + scapular control* beats passive treatments. Cortisone helps short-term pain but doesn’t fix the tendon. Subacromial decompression surgery has similar outcomes to rehab for most non-traumatic tears.

Red flags

Sudden inability to lift arm after trauma, night pain not relieved by position, significant weakness. Get it checked - could be full tear needing surgical review.

Timeline

- Tendinopathy/partial tear: 6-12 weeks for significant improvement

- Post-surgical repair: 4-6 months for return to light activity, 6-9 months for sport

*Key rule*: Pain during exercise is okay up to 4/10 and should settle within 24h. If it’s worse next day, you overloaded it.

Is yours from a sudden injury or gradual onset, and can you lift your arm overhead without pain? That tells me whether we’re dealing with tendinopathy, partial tear, or something needing surgical review.

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