ROTATOR CUFF TEARS: FULL THICKNESS AND PARTIAL THICKNESS, HOW PHYSIO PLAYS A ROLE…
Asymptomatic full thickness rotator cuff tears occur in 4-13 percent of people less than 59 years and 28-51 percent of those between 60-80 (research by Templehof 1999). This means in a lot of people the rotator cuff can tear fully without any symptoms?? The cause is unknown, it could be genetic, or a result of impingement and intrinsic degeneration within the tendon (Rees 2008). Impingement is another common problem where there is poor biomechanics and the tendons of the rotator cuff get ‘jammed’ or squashed under the acromion (point of the shoulder), this causes micro tearing and subsequent swelling, pain and long term degeneration which can lead to full thickness tearing.
Impingement is treated very successfully with Physiotherapy or physical therapy. The best way to avoid having a rotator cuff tear that is not related to heavy trauma is to deal with any shoulder impingement and pains that occur promptly. If you get treatment and fix the problem you can avoid a tear and avoid or reduce tendon degeneration.
FULL THICKNESS ROTATOR CUFF TEARS
IS THIS better to do conservative treatment (physio and strengthening) or does it need surgery?
The good news here is there is a 50% chance (according to the evidence available to date, Moosmayer, 2010 J. Bone and Joint Surgery (Br) that with the right Physiotherapy management program that you will have a good functional return to activity and not require surgery.
The Physiotherapy program is 12 weeks on average required, with activity modification and specific exercises as well as joint and soft tissue manual therapy and treatment.
Anti inflammatory medications are of limited use and sometimes a cortisone injection is helpful. At “Back in action physiotherapy” in Whistler our specially trained sports physiotherapists have all the current evidence and treatment techniques to maximize the chance of recovery. A good sports physiotherapist can also identify those who will most likely not recover and fast track them to a surgeon for repair. There are variables available to the physio that determine who needs to go straight to a surgeon including any history of injury, length of symptoms, size of tear, age and activity levels of the person. After larger tears there are potential irreversible changes that can occur within the rotator cuff muscle such as fatty infiltration and muscle atrophy (Goutallier 1994, 2003).
Research on this topic reports success rates with Physio for full thickness rotator cuff tears between 33 and 83 %. The patients that do the best have minimal impingement testing, external rotation range of more than 52degrees on testing with minor or no wasting of the supraspinatus (rotator cuff muscle) and an intact intramuscular tendon despite having a full thickness muscle tear.
In summary if you tear your rotator cuff fully you may do well without surgery as long as you get the right physiotherapy. A sports physiotherapist that holds post graduate training in sports physio would be the best person to see to make sure the shoulder is on track and also to filter out quickly if you are a surgical candidate more than a rehabilitation candidate. Talk to the experts at Back in action physiotherapy to find out what treatment is best for your rotator cuff tear.
By Back in Action physiotherapy, Whistler BC
ABOUT OUR TEAM
Back in ACTION PHYSIO WHISTLER, ‘we keep you playing’ a whistler based Physio practice consisting of post-graduate trained specialist Sports Physiotherapists: Mike Conway, Therese leigh, Bianca Matheson and Aerin DeLiva. Presently these 4 physiotherapists are the sea to sky corridor’s only titled Diploma/ Masters Sports Physiotherapists holders and have extensive experience in sports injuries from elite to recreational. More importantly the aim is to strive for continual excellence and improvement in the field of injury assessment and rehabilitation.
Please note: the above article is for guidelines only and is not intended to replace the therapist/patient relationship. Back in Action Physiotherapy also advises that rapid advancements and research into sports injuries mean articles may be outdated and a consultation is recommended for up to date information on injuries and conditions.