Age Related Rotator Cuff Tear
What is an age related Rotator cuff tear?
As the rotator cuff tendons age, they become susceptible to age related changes, which can lead to the shoulder not working as it normal does. As the tendon ages it may detach from the humerus and form a defect in the rotator cuff. This is known as an 'age related rotator cuff tear.' Your shoulder can often compensate for any cuff defect (tear), as its onset is gradual over many years and often undetectable. Many people can function normally with an age related tear and approximately 20-40% of people in their 60's have these tears with no pain or noticeable weakness.
However, as we age our tendons do become inherently weaker which makes them more susceptible to tear further with minor injuries, such as a fall or wrenching injury of the arm. These 'acute-on-chronic' tears are often substantial, since there has been a pre-existing defect in the rotator cuff, which has been made larger and surgical input is not warranted.
The Shoulder Joint
There are 3 bones which make up the shoulder complex including the humerus (upper arm bone), clavicle (collar bone) and the scapula (shoulder blade). The three bones in the shoulder region form part of two main joints:
- The gleno-humeral joint between the glenoid of the scapula and the humerus.
- The acromioclavicular joint between the acromion of the scapula and the clavicle.
There are also a number of muscles, ligaments and tendons around the shoulder. Ligaments are fibres that link bones together at a joint. Tendons are fibres that attach muscle to bone.
The Rotator Cuff
What is the rotator cuff?
The rotator cuff is a group of four muscles that are positioned around the shoulder joint.
The rotator cuff muscles work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. Unfortunately, with an age related rotator cuff tear your shoulder function will now be limited. However there is another powerful muscle on the outside of your arm, called the ‘deltoid’ muscle that can be re-educated to compensate for the torn rotator cuff.
What are the symptoms of an age related rotator cuff tear?
Symptoms vary from person to person but may include;
- Pain in the shoulder and upper arm. This may radiate down the arm in more severe cases. It can present as either an ache or a sharp pain, or a combination of the two.
- Pain on activities such as lifting, reaching, overhead movements or driving.
- Pain when lying on the shoulder.
- Pain may be worse at night time and can affect your sleep.
- There may be some mild weakness of the shoulder muscles making it harder to lift your arm.
What can I do to help myself?
Be positive and keep moving! There are many things you can do yourself to help manage your symptoms. There are no quick fixes and it requires active participation from you throughout to achieve your desired goals.
Recent research has shown that a specific exercise plan called the ‘Torbay shoulder exercise plan’ is the best method to retrain the deltoid muscle to compensate you’re the torn rotator cuff muscle.
Exercises should be done three to five times a day to strengthen your deltoid muscle. It will reduce your pain and improve both the range of movement and your arm function. These exercises must be done for at least 12 weeks and must always be performed starting lying down to begin with.
Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.
If you have any issues please do not hesitate to contact the physiotherapy department. If you feel light headed, dizzy or have issues with your breathing please contact your general practitioner (GP) immediately.
When carrying out this exercise program you may feel some discomfort at your Shoulder. It is important that this pain does not exceed 3/10, where 10/10 is the maximal and 0/10 is no pain.
- Lying on your back – lift the bad arm to a vertical position with the help of your other arm. Then hold the bad arm in the vertical position with its own strength for as long as you are able while also keeping the elbow straight. Hold for up to 5 minutes. Bring the bad arm back down to your side with the help of the other arm. As your arm gets stronger, you will be able to lower it to your side without help. When this becomes easy move to exercise 2.
https://www.youtube.com/watch?v=vLPref7tm6Q
- Lying on your back – as the vertical position becomes easier to maintain, the exercise can be progressed. With the elbow straight, start to move your arm forwards and backwards. Try to keep the arm moving in a slow, smooth, straight line and keep it lined up with the side of your body. Repeat for up to 5 minutes or until your arm gets tired
https://www.youtube.com/watch?v=1bXW_YkcTiQ
- As your control and confidence improves begin to increase the range of motion until the arm can move from the side of your body to touching the bed above your head and back again. Continue this movement for up to 5 minutes or until your arm gets tired. When this becomes easy move to exercise 4.
https://www.youtube.com/watch?v=n8ZMzrVutoE
- Lying on your back – the next progression is to add a small weight e.g. a tin of beans, small bottle of water. Hold this in the hand of your bad arm and continue to move the arm from your side to above your head and back again in a smooth movement for up to 5 minutes or until the arm gets tired.
https://www.youtube.com/watch?v=lJ0mqoI41y0
- Once exercise 4 becomes easier to carry out, you can alter the starting position of the exercise by gradually moving from lying on your back to sitting and then to standing. As you begin to sit up, stop using the small weight and start again with just holding the arm in the upright position before carrying out the backwards and forwards movement. Your arm will automatically feel heavier because of the effect of gravity. Repeat for up to 5 minutes or until your arm gets tired
https://www.youtube.com/watch?v=yS_7RiwlyvE
- As the exercise becomes easier again, you can use the weight. If you are having difficulty raising your arm in the reclined or sitting position you can use your good arm to help lift the bad side and then lower it back down under its own strength. Repeat for up to 5 minutes or until your arm gets tired
https://www.youtube.com/watch?v=MeLpvGQHLJE
- Repeat in standing with weight. Repeat for up to 5 minutes or until your arm gets tired
https://www.youtube.com/watch?v=NCddMUK7XJs
- Use a piece of stretchy elastic which your physiotherapist can provide. Tie a big knot at one end, loop it over the top of a door and then close the door. Now stand or sit sideways with the bad side closest to the door. Reach as far up the band as you can with the hand of the bad side. You can use your good arm to help the bad arm to reach higher or it may help if you initially pull the band down with the good arm and then hold on to it with the bad arm. The exercise involves pulling the band down as far as you can and then slowly control the release or upward movement of the band back to the starting position. Repeat this movement for as long as you can control it.
https://www.youtube.com/watch?v=ZGNneSdrUDw 