Massive Rotator Cuff Tears

September 06, 2017 at 11:26 AM

Due to the design of the human shoulder joint, shoulder injuries are extremely common. The shoulder is a ball and socket joint, but unlike the hip joint (which is a stable ball and socket joint) there is a very large ball sitting on a small relatively flat socket. This design allows movement in all directions and substantial flexibility.  

The rotator cuff is the name for the group of muscles that stabilise and move the shoulder joint. The rotator cuff comprises of 4 muscles; supraspinatus, infraspinatus, subscapularis and teres minor. It is common for one or two of these muscles to become torn during injury or as part of ageing. These muscles work together and you can usually still use your shoulder if you have a rotator cuff tear. However, if you have a massive tear this may be a different story.  

In a massive tear, the rotator cuff muscles may become completely torn and retracted. In this case, you may be unable to lift your arm. This is not only painful but significantly limits someones ability to use their arm during activities of daily living. Until recently it was thought that surgery such as a reverse total shoulder joint replacement was the treatment of choice. However, this surgery often relieved pain but did not restore shoulder function. 

Fortunately, our colleagues in England have come up with a strengthening programme which trains another shoulder muscle (the deltoid) to function to lift the arm. This programme will not restore normal shoulder function but can significantly improve pain and function.  The programme takes a minimum of 12 weeks and patients generally start to see improvements after 6-12 weeks.  Results thus far have been very promising with all patients in the studies seeing improvements after 12 weeks. 

For more information please read the summary of the Roberta Ainsworths study or refer to shoulderdoc.co.uk for the exercise protocol.  

We do advise that you discuss the programme with a physiotherapist as they can confirm your diagnosis, track your changes and ensure you are doing the exercises correctly. They may also be able to advise you on other techniques to manage your pain.