The diagnosis of a rotator cuff rupture is made through questioning, examination and possibly ultrasound examination. Whether the rupture is treated surgically depends on several factors. Either way a tear in one of the rotator cuff muscles eventually leads to a rehabilitation program with a physical therapist and a recovery time of four to six months.
A rotator cuff rupture is caused by the (partial) tearing of one of the four muscles surrounding the shoulder. It is a common condition in people 60 and older and is caused by the body's natural aging process. About 25% of people over the age of 60 have a rupture of one of the rotator cuff muscles. Fortunately, at least two-thirds of these people have no symptoms at all. Risk factors for rotator cuff rupture are smoking and high cholesterol. In addition, a hereditary-genetic component also plays a role. Rotator cuff rupture also occurs in athletic younger people (30-50 years old). Here, the cause is often an injury during sports such as some form of strength training but also sports where the risk of falling is greater. Think of mountain biking or snowboarding.
With a tear in one of the rotator cuff muscles, the following symptoms are often present: pain, loss of strength and a limitation in moving the shoulder/arm. Often lifting up is not possible properly.
PASTA stands for Partial Articular Supraspinatus Tendon Avulsion. When there is a PASTA lesion, the tendon of the supraspinatus tendon is not completely torn but only the lower layer has become detached from the bone. This injury occurs almost exclusively at a younger age as a result of a major accident. This variant is less easy to examine and can often only be confirmed through an MRI.
If it is chosen not to operate, a rehabilitation program with the physical therapist will follow. It will then take an average of four months until function and strength are reasonably recovered. The total rehabilitation is quite long, full recovery is often only achieved after 5 to 6 months.Full tendon recovery requires at least 12 weeks. Until then, it is necessary to avoid major strength efforts.
The diagnosis for a rotator cuff rupture is based on an interview combined with typical symptoms and physical examination. The physical therapist performs a number of specific tests to determine if a rupture has occurred and which muscle is affected. In addition to these tests, ultrasound can help with diagnosis. Our bodies are subject to wear and tear as we age. It is normal from a certain age to sometimes see tears in tendon tissue. Therefore, we must remain cautious in what stamp we put on some symptoms.
A torn tendon will not heal on its own but neither is it always operated on right away. Which treatment method is chosen depends on several factors. Often good steps can be made in recovery with physical therapy. The goal of physical therapy will be to improve the strength of surrounding muscles and reduce pain using mobilizations and exercise therapy. Sometimes this is done in combination with pain medication (NSAIDs). Should surgery be chosen, the torn tendon will be replaced (as close as possible) to its original location. Then, in the first phase, the physical therapist will provide an increase in mobility; slowly, work will also be done to restore strength.
A tear in one of the rotator cuff is more common in people who play a sport where injury is more likely. Think falls or large peak loads. But there can also be a natural process. From the age of 60 we see that the quality of tendon tissue decreases, which can cause injuries to occur more quickly. Ultrasound can help in making a correct diagnosis especially when there is a significant fall or when there is great force on the tendon due to peak loading. Rehabilitation will always consist of gradually increasing mobility and slowly training strength again.