Why it can be Normal to have a Tear in your Rotator Cuff
So you have a sore shoulder?
Don’t despair, you are not alone! It can be quite common to have a sore or stiff shoulder at some point in your life, even without an injury.
A common pathway for a person living in the community is to visit the GP after the onset of shoulder pain. This would often result in a referral to a medical imaging clinic where an XRAY and diagnostic ultrasound would be undertaken to help aid in assessment.
So you go back to the GP and find out…………..(SHOCK HORROR!)
You have a torn rotator cuff and a substantially thickened bursa!
This sounds horrible, I agree, but I am going to explain to you why it is most likely all going to be ok.
The shoulder is a shallow ball and socket type joint which means it isn’t held in very well by the bones and ligaments and relies heavily on muscles to support it. This has some advantages (it’s super flexible and can usually scratch your back in those hard to get places) and some disadvantages (it can pop out on occasion).
The Rotator Cuff is a group of four muscles that surrounds the shoulder and helps with stability of the shoulder and movements in all directions.The Rotator Cuff is a group of four muscles that surrounds the shoulder and helps with stability of the shoulder. #performbetter @pogophysio Click To Tweet
It is labelled a ‘cuff’ because the tendons of all four muscles mesh together and encapsulate the shoulder in a flat blanket like structure. Sounds cosy right!
It’s important to think about mechanics of the rotator cuff tendon at this stage before we go delve into tears. Because the four tendons of the rotator cuff are actually more like one big blended one, it is very hard to isolate one muscle of the rotator cuff. So in reality, instead of four different muscles, we have one big blanket of tendon that can use a variety of forces to achieve the movement we want. It would be like 4 people each holding onto a part of superman’s cape as he dangles off the edge of a balcony (which would be silly anyway because superman can fly). Each person can pull a little more or a little less to lift superman up a different way!
How can a tear be normal?
As we age it is normal for certain parts of our body to become ‘worn’ looking under medical imaging. This is well documented in most body parts with the shoulder being no exception.
In people aged 50 to 59 years, 13% (22 of 167) of the patients had tears; in group 2 (aged 60 to 69 years), 20% (22 of 108) of the patients had tears; in group 3 (aged 70 to 79 years), 31% (27 of 87) of the patients had tears; and in group 4 (age >80 years), 51% of the patients had tears.
Can a tear be abnormal?
Yes! If a rotator cuff tear is causing a severe lack of strength which is causing you to be restricted in day to day actions regardless of pain then your tear is abnormal and will need a thorough assessment by a highly knowledgeable health professional to determine what management strategies you should employ.
So, when it all boils down, the main message is:
How you move is much more important than what your scan looks like;
or even most times how much pain you are in, because, pain we can get better, but if something isn’t working when it should be, it can be hard to fix without surgery.
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Edwards, P., Ebert, J., Littlewood, C., Ackland, T. and Wang, A. (2017). A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair. Journal of Orthopaedic & Sports Physical Therapy, 47(12), pp.931-944.
Yamaguchi, K., Tetro, A., Blam, O., Evanoff, B., Teefey, S. and Middleton, W. (2001). Natural history of asymptomatic rotator cuff tears: A longitudinal analysis of asymptomatic tears detected sonographically. Journal of Shoulder and Elbow Surgery, 10(3), pp.199-203.