In our last 2 newsletters, we have discussed shoulder mobility and also some common shoulder injuries. The first injuries we discussed were the 5 types of AC joint sprains. Another very common shoulder injury is a rotator cuff tear, in particular, Partial thickness rotator cuff tears.
The rotator cuff muscles attach the humerus to the scapula and are involved in rotating the arm or shoulder joint through internal and external rotation, and elevation. All the muscles come together and insert on the humerus within the same vicinity. An injury to the rotator cuff may result in a tear at the tendon close to the attachment point. Tears are classified as partial or full thickness tears. As the words suggest, a partial tear goes through “part of the thickness” of the tendon. Whereas, a full thickness tear is a tear that pierces through the entire thickness of the tendon. With partial tears, the tear can occur on the articular side, the underside of the tendon, or the bursal side which is the top side of the tendon as in the diagram below. With full thickness tears, there are some other terms used to describe the shape of the tear, i.e “u-shaped”, “L-shaped”, etc… The main difference though, is whether the tear does through the entire tendon or not, as seen in the diagram below to the far right.
Symptoms of a partial thickness tear
- Painful range of motion (between the ranges of 70 and 120degrees)
- Shoulder weakness with lifting
- Pin point tenderness at the lateral shoulder
- Pain that worsens at night or with rest
Is Surgery required?
I am not a surgeon, but in my history of treating rotator cuff tears, there many variables to consider when discussing surgical intervention. Generally, a partial thickness tear does not require surgery, unless there is a significant impact on the patients functional ability and or the mode of onset was traumatic (1 specific incident that caused the tear). An overhead athlete in a high level of sporting competition, may require surgery to continue at the same level.
Rehab for partial thickness tears
Phase 1: Reduce pain/swelling and work on pain free range of motion.
Ice can be used initially to help reduce any inflammation as a result of the tissue damage. After 72 hours, you can add heat to help bring blood full of nutrients to the area. Maintaining mobility is very important here but at the same time we don’t want to over stretch an area where there is a tear so stretching is kept to a minimum.
Phase 2: Add resistance and maintain pain free range of motion.
Once mobility has been restored, resistance can be added to work on strengthening which will reinforce the added motion and begin the redevelopment of full function.
Phase 3: Work or sport/work specific skills
As strength improves throughout the normal ranges of motion, more sport or work related motions can be retrained. This helps work on the coordination of multiple muscles working together to perform a task or action.
Can a partial tear heal?
This is a very common question we hear. Post rehab ultrasounds of partial tears and full thickness tears show that the tear does not heal (1), meaning, the broken ends do not rejoin or fill in with scar tissue, but may be then classified as a)asymptomatic or b)symptomatic. In the asymptomatic individuals, there was no progression to a larger partial thickness tear or to a full thickness tear. However, in those in which symptoms continued or got worse, 40% had progressed to a full thickness tear (2).
With treatment for pain initially and guided rehab, most tears recover to full range of motion. Depending on the work that patients put into it, strength may or may not return to pre-injury status.
If you are experiencing shoulder pain and would like to have an assessment, we would love to help you. To book an appointment, CLICK HERE or any of the Book an Appointment buttons found throughout our website.
References:
- Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604
- Mall NA Kim HM Keener JD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92(16):2623–2633.