So you’ve had some shoulder pain, seen your doctor, had a scan and been given the news you have a torn rotator cuff! Oh no, it’s the end of life as you know it right? A torn rotator cuff means surgery is the only option right? WRONG! Read on to learn about how your cuff tear is a normal part of the ageing process, and surgery is likely not your only option.
Unfortunately we see a lot of people who’ve “come to terms” with a rotator cuff tear diagnosis, thinking this means they’ll live the rest of their life plagued by shoulder pain and limitation. The good news – this isn’t the case! There’s LOTS of misinformation out there when it comes to cuff tears of the shoulder, so read on to get a little clarity.
Firstly, cuff tears are VERY common, even in people without shoulder pain.
It’s well known by health practitioners who pay attention to the literature that there are a lot of people living their lives with tears in their rotator cuff tendons without pain or affected function. There was an interesting study done in Japan in 2013. As part of the study, researchers found 664 people in Japan who then underwent shoulder scans – 147 cuff tears were found in these people, with only 35% of those with tears having any shoulder pain at all. See where are we going with this?
Similarly, a study from 1999 examined the shoulders of over 400 people (all with no pain or verbalised problems) and found that 23% of them had rotator cuff tears. They also found the older you are the more likely you are to have a tear. If we look more specifically at particular age groups, over half of all the 80 year olds in the study had cuff tears but reported no shoulder trouble whatsoever.
What about the younger or sportier demographic you ask? A study in 2003 (Conner et al.) demonstrated the following…
Up to 40% of elite overhead athletes have rotator cuff tears, again with no reported problems
What does this all mean?
Basically, that having a cuff tear doesn’t mean you need to have shoulder pain or reduced function. There’re plenty of people living normal lives without shoulder pain, all with cuff tears in their shoulder without even knowing it! More specifically:
The presence of tears seen in those over 50 with no symptoms is high enough to be considered a normal sign of ageing (Teunis T 2014)
Okay, so they’re there in lots of people even without pain. But what should I do? Rehab! Then some rehab, and a bit more rehab after that! In conjunction with some activity modification of course.
A study that looked at the effectiveness of rehab using a physio rehab program found:
Non-operative treatment using a physiotherapy rehab protocol is effective for treating non-traumatic full thickness rotator cuff tears in approximately 75% of patients. That means in one particular study, out of the 452 people included, 339 of those avoided surgery and saw good improvements in pain and function. (Kuhn et. al 2013).
But you’ve tried rehab you say? Remember, rehab is only as effective as we want it to be if done using the following criteria.
– Often enough (2-3 times per week)
– For long enough (12+ weeks)
– Intense enough (7/10+ “difficult”)
Tick these boxes, and it’s likely you’ll do well!
But won’t exercise make my tear worse?
A 2017 paper (Keener et. al) looked at 346 people with rotator tears, who had NO PAIN or issues were monitored over 4 years to see if exercise increased the tear size or levels of pain and disability. They found:
Higher activity levels or occupational demand was NOT associated with cuff tears increasing in size. In fact they found that those who developed more shoulder pain were LESS active than those who did not develop more shoulder pain.
Exercise and activity can be protective against the development of pain with cuff tears. That’s not to say that exercise or activity definitely won’t worsen a cuff tear or cause more pain, but you can’t say that it definitely will either.
I’ve been told I need surgery. When should this be considered?
Some of the factors that influence when surgery should be considered for rotator cuff tears are the following:
- Severe shoulder pain and disability of a sudden onset
- Tear confirmed on scan that is greater than 1.5cm and involves 2 or more tendons (Collin 2015)
- No improvement with 3 months of activity modification and rehab
- High levels of night pain
- If you have a physically demanding job or sport
- Are in good health with small involvement of other pain-contributing factors
- Are aware of the risks, and the time and commitment to rehab following surgery
In doubt? Consult an expert Physiotherapist for an assessment. It’s likely they’ll have the knowledge to develop a plan to get you back feeling your best.
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