The rotator cuff is a very complex part of the shoulder. It contains 4 muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons of these muscles run through the subacromial space to insert onto the humerus. If there is a narrowing of this space it can lead to an impingement which can cause excessive friction on the rotator cuff tendons and eventually lead to a tear of the rotator cuff. A tear can also come from a fall onto an outstretched arm.
What does the rotator cuff help me do?
Helps with rotation of the humerus, raising the arm overhead, and allows for stabilization of the shoulder when muscles around it contract.
What can cause a tear?
Falling onto an outstretched arm, repetitive movements of the shoulder such as pitching in baseball, and bone spurs causing friction on the tendons.
Symptoms of a tear
1. Pain or Pain free. Pain free!? Yes a total tear will result in no pain and inability to raise the arm due to a feeling of weakness.
2. Pain with overhead activities
3. Unable to sleep on the side of which the RTC is torn.
4. Difficulty with reaching behind
5. Muscle atrophy and feeling of weakness with shoulder movement
Unfortunately a tear is tear and can only be fixed with surgery. You may have pre-operative physical therapy to restore some range of motion before surgery for an easier recovery after surgery. After surgery you can expect to start physical therapy as early as the next day. You will be in a sling for about 4 weeks. Post-operative physical therapy lasts about 4-5 months.
What happens in Physical Therapy
Typically physical therapy protocol is 0-6 weeks you perform PASSIVE RANGE OF MOTION ONLY. This means the therapist will move your arm for you and you are not allowed to move your arm on your own, even at home.
6-8 weeks begins active assistive range of motion, meaning you can assist your arm with movements, but still cannot move the arm independently.
8-12 weeks you will begin active range of motion and move the arm independently.
12+ weeks, begin strengthening and return to functional activities.
HOWEVER, this protocol may vary depending on your MD and if your MD has their own protocol.