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A Painless Rotator Cuff Tear??

Shoulder pain affects approximately 16% to 21% of the population and is second only to low back pain in prevalence.1

I often hear from patients that their shoulder started hurting one day and upon going to their physician, they are referred for imaging and find out they have a rotator cuff tear.

The patient is referred to physical therapist services (PT) and a common question is: “How can PT help me, if the muscle is torn?

To answer this question it is important that you first understand more about the rotator cuff and the research that we have about tears of these muscles.

The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that work together to stabilize the shoulder joint during motion. People experiencing rotator cuff related shoulder pain often experience pain with shoulder elevation and overhead motions, weakness raising the arm and difficulty sleeping. Tears can be classified as full thickness if the tear is completely through the tendon or a partial thickness if it only goes part way through the tendon. Interestingly, how a patient feels is not often correlated with the results of imaging.

Studies have shown that many people in the general population have rotator cuff tears but do not have pain and that prevalence increases with age. In a study performed by Tempelhof et al, out of 411 people sampled without shoulder pain, 13% of those aged 50-59 years old had full thickness rotator cuff tears, 20% aged 60-69 had tears, 31% aged 70-79 had tears, and 51% had tears over the age of 80 years old.2 Overall, 23% of the sample population had full thickness rotator cuff tears and none of them had pain with active shoulder elevation.2 Moreover, it has been seen that small partial tears can disable some patients, while others demonstrate no symptoms or functional limitations despite massive rotator cuff tears.3 This leads us to the question if the tear was present before the pain started and was accidentally discovered when searching for a source of pain. In fact, the origin of pain in many individuals can be unclear and treatment is most successful when it targets an individual’s specific impairments (like muscle imbalances, poor posture, tissue restrictions, limited range of motion, etc).

That is why we at Integral Physical Therapy believe that it is important to treat the individual and not the diagnostic image. Our goal is to work with you to create a treatment plan to help you attain your goals, whether that be reaching up into a cabinet pain-free or resuming your favorite hobby. Physical therapy utilizes manual interventions to decrease pain along with progressive exercise to restore your function so you can return to performing your daily activities without difficulty.

For those who do require surgery, the therapists at Integral Physical Therapy will work with your surgeon to provide shoulder rehabilitation to decrease stiffness, increase shoulder range of motion and help manage postoperative pain to return you to normal activity.

References 1. Tate AR, McClure PW, Young IA, Salvatori R, Michener LA. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: A case series. J Orthop Sports Phys Ther. 2010;40(8):474-493. doi: 10.2519/jospt.2010.3223. 2. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. Journal of Shoulder and Elbow Surgery. 1999;8(4):296- 299. doi: 10.1016/S1058- 2746(99)90148-9. 3. Cuellar VG, Lerebours F, Strauss EJ. Nonoperative Management: Who, When, and What? Operative Techniques in Sports Medicine. 2012;20(3):207-212. doi:10.1053/j.otsm.2012.08.001.


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