Conservative Treatment for Rotator Cuff Tears

90% of Rotator Cuff Tears can be treated conservatively and without surgery!

Rotator Cuff tears are one of the most commonly talked about injuries amongst active adults and recreational athletes; however, too often people don’t understand exactly what the rotator cuff actually is or how to appropriately address the injury without jumping to an unnecessary conversation about surgery.

Rotator Cuff Tears are common because of the inherent instability of the shoulder (due to a lot of normal shoulder mobility), making the rotator cuff prone to injury with repetitive stresses - notably with overhead activities and/or throwing activities. 

Rotator cuff tears can occur traumatically from one specific injury or even over time due to degenerative changes from repetitive movements. 

And while I’m thinking about it, let's talk about the term “Rotator Cuff Tear.” I hate this term. I understand it is a “street term” and the normalized term to describe the injury - but it paints an incorrect picture of the injury and honestly I feel it is fear mongering. 

We see the word “tear” and our brains envision a tear in a muscle as if it is a tear in a sheet of paper. When we see "tear," we instinctively believe the only way to “fix the tear” is with surgery. But really, a rotator cuff tear is nothing more than a muscular strain involving one or more of the rotator cuff muscles. 

OK, back to the purpose of this blog!

First, let's address the elephant in the room: What is the Rotator Cuff?

When talking about the rotator cuff, we are chatting around a grouping of muscles with specific functions at the shoulder. The rotator cuff is technically a group of 4 specific muscles at the shoulder - and for those interested in the names, they are the supraspinatus, infraspinatus, teres minor, and subscapularis. 

The rotator cuff does not directly include other nearby structures such as the AC Joint, Biceps tendon, ribs or labrum; however, as with all injuries, other structures play an important role in rotator cuff function, injury prevention, and injury rehab. 

Let's go ahead and dive into the functional anatomy of the RC next, shall we?

Anatomy and Function Review:

These 4 muscles of the rotator cuff serve 2 important functions:

1. Rotate the shoulder: this one is relatively obvious and straightforward. These muscles play a large role in the rotational movements of the shoulder - namely internal and external rotation.

2. Stabilize the shoulder with overhead movements. This is by far the most important role of the rotator cuff muscle group and the usual first thing a patient reports about their shoulder pain (pain while raising the arm overhead). 

   1. The 4 muscles of the rotator cuff co-contract (contract at the same time) with overhead movements to stabilize the humeral head (golf ball) in the shoulder socket/glenoid/shoulder blade (golf tee). If one of these rotator cuff muscles is injured, weak, or isn’t firing properly, then the arm bone will not stabilize into the shoulder socket and pain can occur. 

But alas, here comes the tricky part in differentially diagnosing a rotator cuff tear - as there are a litany of other injuries that can mimic a rotator cuff injury or trick an unskilled provider. 

These other injuries may include (plus more that won’t be listed):

• 2nd rib syndrome

  • This is more common that most give credit, especially if you have received rotator cuff specific treatment for months or years without relief. 

• Impingement Syndrome

  • Admittedly, this diagnosis is commonly found alongside a rotator cuff injury. One can even have a “chicken or the egg” conversation regarding this diagnosis.

• Subacromial Bursitis

  • Irritation of the bursa can lead to a pinpoint pain at the same spot RC tears are reported. 

• Cervical Radiculopathy

  • I would think by now that the neck would be screened for any patient who presents with shoulder pain, but this diagnosis is still routinely missed in patients with chronic shoulder pain. I’ve personally seen patients who underwent exploratory shoulder surgery without success when the problem was never the rotator cuff in the first place. 

• Bicep Tendonitis

  • Due to the close proximity and functional similarities of the biceps muscle (lifting the arm overhead), irritation and injury to the biceps tendon can be mistakenly confused with a rotator cuff tear. 

So you’ve established you have a rotator cuff injury, or simply shoulder pain in general, what next?

First thing worth noting is that over 90% of rotator cuff tears can be successfully treated without surgery. This is great news because, as I always tell my patients, once you have surgery, you can’t go back. 

Bottom Line: Rotator Cuff Tears do not equal Surgical Intervention

Conservative treatment for a suspected rotator cuff tear will always begin with a thorough initial evaluation with your Physical Therapist. This evaluation will tease out which exact structures are involved, and which specific muscles of the rotator cuff are involved. 

You will likely be asked to raise your arm overhead, which gives insight into the severity of the suspected tear. 

Once you have a true root cause diagnosis of the specific pain generating structures, treatment can begin with a comprehensive physical therapy plan of care consisting of a varying combination of:

• Manual Therapy (Hands-on therapy)

  • Muscle Stretching, Joint Mobilizations to the shoulder blade, neck, mid back, and shoulder, Massage/Cupping/Scraping

• A specific corrective strengthening and mobility based exercise program

  • This should always extend beyond the yellow theraband exercises so commonly overused in the exercise rehab world. There are so many options in this realm it can be dizzying - including incorrect options.

    • Side note - this program must include proper spinal/thoracic mobility exercises due to the relationship of the thoracic spine and shoulder mobility.

• Dry Needling

  • The research on the benefits of dry needling has steadily expanded over the years and we have now proven and established tendon healing protocol to assist in healing injured tissue. 

  • Additional benefits of dry needling - extending beyond the cliche improved range of motion and flexibility - include:

    • Stimulation of the non-opioid descending pain pathways from the brain - releasing serotonin and norepinephrine to modulate pain perception.

    • Anti-inflammatory properties by inhibiting inflammatory enzymes.

    • Dry Needling provides a nervous system reset in chronic cases. 

Where can you find all of these treatments under one roof?

Start with locating a Fellowship-trained, Osteopractic Physical Therapist! And if you live in the Lafayette, LA and/or Acadiana region, Flow Physical Therapy provides Osteopractic Physical Therapy for your shoulder/rotator cuff injury.

Osteopractic Physical Therapy will always start with a proper and thorough differential diagnosis to uncover the source of your pain, while subsequently providing expert treatment options based on clinical expertise in treating orthopedic injuries. 

If you are living in Lafayette, Youngsville, Broussard, Scott, or surrounding areas and need more guidance for your shoulder injury, then click the link below to get started with Osteopractic Physical Therapy right in your backyard. 

Click Here to Get Started

Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT

Owner of Flow Physical Therapy and Wellness

337-366-1703