What is a Rotator Cuff Tear? rotator cuff tear is quite simply a tear within your shoulder’s rotator cuff tendons. A rotator cuff tear can occur in two ways: trauma, and repeated microtrauma. Traumatic rotator cuff tears occur quickly or under heavy load eg a fall or lifting a heavyweight. However, the most common cause of a rotator cuff tear is repeated microtrauma, which can occur over several weeks months or years. Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft tissue resulting in bruising or swelling. Since there are only a few millimetres separating your rotator cuff tendons from a bony hood (acromion), the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons. What are the Symptoms of a Rotator Cuff Tear? Your rotator cuff tears may be partial or full thickness tears. You will notice that your shoulder pain and weakness increases with the severity of your rotator cuff tear. More importantly, it is a reduction in your shoulder function that is important. Partial rotator cuff tear may only present with mild shoulder pain, clicking during shoulder elevation and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back. Full thickness rotator cuff tear will normally present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases, the rotator cuff tear is so severe that a significant number of your pain fibres are also torn, which can make them less painful but very weak. When you have a small rotator cuff tear you can often still raise your arm with or without pain. Moderate tears are usually very painful and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a large rotator cuff tear occurs you may find that you are unable to lift your arm at all. What is the Rotator Cuff? Your shoulder’s rotator cuff is a very important group of four small shoulder muscles that stabilise, control and move your shoulder joint. When your rotator cuff muscles work in isolation they exhibit rotational motion at the glenohumeral (shoulder) joint, which is why they are termed the rotator cuff. Your subscapularis, supraspinatus, infraspinatus and teres minor muscles are the four muscles collectively known as the rotator cuff. How is a Rotator Cuff Tear Diagnosed Your physiotherapist or sports doctor will suspect a rotator cuff tear based on your clinical history and the findings from a series of clinical tests. A diagnostic ultrasound scan is the most accurate method to diagnose the size and location of your rotator cuff tear. MRI’s may show a rotator cuff tear but have also been known to miss a tear. X-rays are of little diagnostic value when a rotator cuff tear is suspected. What is the Best Treatment for Rotator Cuff Injury? Small and medium-sized rotator cuff tears usually heal successfully with appropriate conservative management and rotator cuff physiotherapy treatment. Physiotherapy is normally one of the first treatment options suggested by your doctor or shoulder specialist. If conservative treatment methods have failed to settle your symptoms, or you have an added shoulder bursitis, you may be recommended a corticosteroid injection. These injections may improve your pain while sleeping or allow you to perform your rotator cuff exercises. Corticosteroid injections are known to potentially weaken your tendons, so prescription of an injection will be judicious. Unfortunately, larger rotator cuff tears may require rotator cuff surgery (arthroscopic or open) if physiotherapy treatment fails to assist. Massive rotator cuff tears may require shoulder replacement or reverse shoulder arthroplasty to restore some of your shoulder function. Post-operative physiotherapist guided rehabilitation will be required to safely regain your shoulder function. Early rotator cuff tear treatment is important. Delay will result in retraction of your rotator cuff tendon, which can make healing or rotator cuff repair surgery more difficult and less successful. The best rotator cuff tear treatment results occur when the rotator cuff injury is fresh.  Rotator Cuff Tear Treatment Rotator cuff tears are a common problem. Rotator cuff injury deteriorates further if you return to sport or work too quickly – especially if a thorough rehabilitation program is not completed. They are also regularly poorly treated by inexperienced shoulder practitioners. Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents other shoulder injuries such as rotator cuff impingement or shoulder dislocation. Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate rotator cuff tears and prevent recurrence. These are: 1. Early Injury Protection: Pain Relief & Anti-inflammatory Tips 2. Regain Full Shoulder Range of Motion 3. Restore Scapular Control 4. Restore Normal Neck-Scapulo-Thoracic- Shoulder Function 5. Restore Rotator Cuff Strength 6. Restore High Speed, Power, Proprioception & Agility 7. Return to Sport or Work Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.