Physical Therapy Assistant Guide

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THE Definitive Guide to Rotator Cuff Tears

Rotator Cuff Tear Diagnosis & Treatment Guide

We use our shoulders more than we realize. In fact, we constantly should be engaging our shoulders slightly in order to hold a good healthy posture. Studies have shown that hunching can actually contribute to rotator cuff injuries and other shoulder injuries over time.

Because our shoulders are engaged constantly and used frequently, shoulder pain is not something you want to live with, it will constantly nag you and effect you throughout your entire day. The pain will limit many of your movements needed to perform daily tasks in addition to creating discomfort.

Regardless of whether you work at a desk and computer, or lift heavy objects over your head, you are prone to rotator cuff and other shoulder injuries. Everyone from young to old and from desk worker to professional athlete may experience the dreaded rotator cuff tear.

More commonly shoulder pain is from rotator cuff overuse tendonitis, or sometimes from shoulder impingement syndrome but more serious cases can result in a rotator cuff tear.

The good news is that all of these injuries can be rehabilitated through physical therapy. In fact the chances of them occurring can also be reduced by practicing preventative physical therapy.

We will cover everything PTAs need to know about treating and preventing rotator cuff tears through physical therapy.

The Guide to Rotator Cuff Tears

What Is a Rotator Cuff Tear?

Rotator Cuff Tear

  • Their are four shoulder muscles that make up the rotator cuff. A rotator cuff tear occurs when at least one of the tendons from these muscles tears. Additionally, there are rotator cuff injuries that can occur instead of a tear. These injuries may include overuse or inflammation of this muscle group or tendons, resulting in tendonitis or shoulder impingement.
Rotator Cuff Tear Overview & Surgery Graphic - the Definitive Guide to Rotator Cuff Tears by the PTA Guide

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Rotator Cuff Tear Overview

A group of four muscles known as the rotator cuff helps keep the shoulder joint stable. However, this muscle group can be injured easily due to overuse of the shoulder as it is subject to high load and a lot of surface wear. Rotator Cuff injuries also occur partly because the area doesn’t receive much blood and these muscles wear out over time.

The injury can vary as the person ages. The condition is more common during old age, in fact the majority of rotator cuff tears occur in patients over 40, but they can occur during young age too. Older folks can injure this muscle when they fall or strain the shoulder during various movements.

One common incident among older people occurs when they fall and use their arm to reduce the impact of their body on the ground, which can place high pressure on the rotator cuff resulting in a tear. Another common occurrence is walking a medium or large dog where the dog pulls on the leash jerking the person’s arm hurting their rotator cuff. Even young athletes and heavy laborers are affected with this condition. If left untreated for a long period of time, it will cause severe pain and inability to use the arm effectively.
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Full & Partial Rotator Cuff Tears

The rotator cuff muscle connects the upper arm bone a.k.a. humerus to the shoulder blade. The main function of this muscle is to keep the shoulder joint stable. Repetitive arm movements, heavy lifting or a sudden fall will make this joint inflamed or irritated at times which results in rotator cuff tendonitis, or shoulder impingement syndrome. When the injuries to the muscle causes tissue damage, a rotator cuff tear would occur.

The rotator cuff tears are categorized as “full thickness” or “partial thickness” depending on their severity.

Full Thickness TearPartial Thickness Tear

A full thickness tear will consist of a tear that covers the whole area from the top to the bottom of the rotator cuff muscle.

A partial thickness tear will affect a part of the muscle so that the tear doesn’t cover the whole area from top to bottom.

These tears can happen in two ways. They can either occur due to repeated overuse of the shoulder over time or instantly during a traumatic event. Accordingly, tears are classified as chronic or acute in nature. An acute rotator cuff tear is one that occurs instantly versus over time. This can be due to lifting a heavy object or a fall. Chronic tears develop in a much slower rate from use over time. These usually happen due to repeated actions with the arms working above the shoulder level.

Both acute and chronic rotator cuff tears could be from tennis or some other ball throwing sport that leverages the shoulder extensively or similar work activities lifting weight overhead.

Acute InjuryChronic Injury

During an acute injury, the patient would experience sharp pain the moment the tear occurred and would need immediate treatment.

During a chronic injury the patient would experience aches and pain increasing over time as the rotator cuff became inflamed, weakened, and slowly torn over time.

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People who experience rotator cuff tears usually have a history of rotator cuff tendon irritation, known as rotator cuff tendonitis, which causes shoulder pain with movement. It is also commonly referred to as SIS or shoulder impingement syndrome.

Rotator cuff tears can also occur in connective with irritation or injuries of the biceps muscle at the shoulder. Sometimes with labral tears to the ring of cartilage located at the shoulder joint.

Identifying a Rotator Cuff Tear

You likely have a rotator cuff tear if you experience the following and may want to get a professional diagnosis:

  • weakness of the shoulder
  • pain on the top of the shoulder
  • loss of motion in the shoulder area
  • crackling sound in the shoulder area

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The injured arm will usually feel weak, heavy and painful. In more severe cases, the pain will prevent the patient from performing day to day activities or even raising his or her arm. They cannot lift the arm to reach high shelves or reach behind their back to tuck in their shirt.

What Are The Main Symptoms of a Rotator Cuff Tear

The following are some of the major symptoms of rotator cuff tears:

  • Certain shoulder movements and positions result in a crackling sensation.
  • Pain when laying down, specifically when laying on the side of the affected shoulder.
  • Weakness in your arm when performing lifting, rotating, and lowering movements.
  • Pain from specific movements requiring lowering and lifting of your arm.

Diagnosing a Rotator Cuff Tear

Your therapist will review your medical history, conduct a series of tests and perform a thorough examination to diagnose the condition. Hawkins-Kennedy impingement test, external rotation lag sign and Neer’s impingement sign are some of the common tests conducted to diagnose the illness.
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Hawkins-Kennedy impingement Test

Your therapist will raise your arm, move it to side or ask you to resist the force while raising your arm at specific angles of elevation to diagnose the condition. Even though these tests may cause you to feel some discomfort, it is normal. You should worry too much about this since it is part of what helps the therapist identify the root cause of your condition. Sometimes, the results of these tests might indicate the requirement for a referral to an orthopedist for imaging tests such as computed tomography (CT), ultrasound imaging or magnetic resonance imaging (MRI).

How Will A Physical Therapist Help?

A PT discusses your chances of healing a torn rotator cuff:
A Physical Therapist can assess your rotator cuff tear to determine if it is actually simply tendonitis or impingement or confirm that it is a full or partial tear and how severe it is. The PT will help you to determine whether surgery is needed and/or the best rehab exercises that will help your specific case of the injury.

A PT explains how physical therapy helps patients after their rotator cuff repair surgery:
If you ended up needing surgery to repair your rotator cuff tear, then this video will help explain how a PT helps patients post-surgery to fully heal their rotator cuff and regain maximum use of their shoulder.

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Once your condition is diagnosed as rotator cuff injury, your orthopedist or physical therapist will decide if you need surgery or your condition can be healed without surgery. If it doesn’t require surgery, your therapist will work with you in order to restore the mobility of your shoulder joint. They will work to restore the muscle strength, coordination and range of motion so that you are able to conduct your day to day activities. In some cases, the therapist will help you learn to modify your daily activities so that you place less stress of the shoulder. If the therapist decides that you should have surgery, he or she will help you before and after such surgery. Regardless of the kind of treatment method early treatment can definitely speed up the healing process and avoid permanent damage to the shoulder.

Acute Injury Treatment

If the rotator cuff tear happens due to a trauma, you need to seek immediate medical assistance in order to prevent the possibility of damaging your shoulder muscle permanently. Go to your physical therapist or any other healthcare provider immediately under such circumstances. Once serious injury is ruled out by the healthcare provider, he or she will help manage your pain and prepare you for the best course of treatment.

Chronic Injury Treatment

Your healthcare provider will help manage the symptoms of chronic rotator cuff tears and improve the mobility of your shoulder. For large rotator cuff tears which cannot be repaired fully, your therapist will teach special strategies to improve your shoulder movements.
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How Inflammation and Pain Are Reduced In Rotator Cuffs

Try the following to reduce inflammation and pain of the rotator cuff:

  • Place a thin towel over your shoulder to protect the skin and ice the injured area for up to 20 minutes 2-3 times per day
  • Avoid movements and activities that increase pain
  • Rest your affected arm and consider wearing a sling to reduce daily use
  • After 2-3 days of consistent icing, try applying a warm moist towel over your shoulder, relax the shoulder slight leaning forward with your arm hanging and slowly swing your arm like a pendulum
  • Take an anti-inflammatory drug that is nonsteroidal, aka a NSAID, like Ibuprofen.

Are Rotator Cuff Tears Preventable?

Your physical therapist is the best person to help prevent your risk of worsening or developing a rotator cuff tear. It is important that you seek assistance in the first sign of a shoulder pain or discomfort. It is vital that you avoid future exacerbation if you want to avoid developing an existing shoulder impingement into a rotator cuff tear. Your therapist will help you strengthen the rotator cuff muscles and train you to avoid harmful positions in the process. He or she will determine whether it is appropriate that you return to normal day to day activities.

Rotator Cuff Injury Exercises & Treatment Plans

Rotator cuff injuries can be rehabilitated with specific rotator cuff injury exercises. You can even do exercises before an injury for prevention, but most of the exercises you find will consist of rotator cuff exercises after injury for rehabilitation. We have researched some of the top rotator cuff exercises using resistance bands, dumbbells, and no equipment. Below is a list of the most effective rotator cuff exercise treatment plans including PDFs.

Look through these for the best program for you and then you can get further instruction from our list of the best rotator cuff exercise youtube videos. After you look through the exercise videos and PDFs make sure to also read the list of rotator cuff exercises to avoid.

The 7 Step Rotator Cuff Treatment System by Brad Walker

7 Step Rotator Cuff Treatment System by Brad WalkerBrad Walker has a health science degree and postgraduate accreditation in Athletics, Swimming, and Triathlon Coaching. He has nearly 40 years experience with stretching, injury and pain management, and flexibility. He has developed a specific rotator cuff injury treatment plan. This is great for anyone experiencing chronic pain that needs to rehab their injury to prevent a rotator cuff tear or rotator cuff surgery.

Brad’s program is very comprehensive. It consists of a 7 step rotator cuff recovery system that comes in a 3 ring binder (downloadable PDF available) containing 50+ color pages explaining in great detail all of the stretches and exercises for rehabbing your rotator cuff injury. Additionally you will receive a recovery log to track progress, a getting started guide, a pack of therabands, a reusable hot cold pack, and unlimited email support.

American Academy of Othopaedic Surgeons: Rotator Cuff & Shoulder Conditioning Program

Get the AAOS Rotator Cuff Conditioning Program PDF DownloadAfter a rotator cuff tear surgery, or after completing therapy for the pain, you will need to begin strength and flexibility conditioning in order to regain your ability to perform daily activities. Following a well-structured shoulder conditioning program is essential to getting back to enjoying your active healthy lifestyle, especially if you are trying to return to sports and other recreational activities.

This program by the AAOS will help you regain strength and flexibility in your rotator cuff muscles and surrounding shoulder muscles. The program targets the following muscle groups:

Deltoids (front, back, & over the shoulder)
Trapezius muscles (upper back)
Rhomboid muscles (upper back)
Triceps (back of upper arm)
Biceps (front of upper arm)
Subscapularis (front of shoulder)
Teres muscles (supporting the shoulder joint)
Infraspinatus (supporting the shoulder joint)
Supraspinatus (supporting the shoulder joint)

Thera-Band Rotator Cuff Strengthening (Beginner)

The PerformanceHealth Academy – Theraband Academy is partners with the APTA and offers a beginner strengthening program for rotator cuffs. You will need a resistance theraband for this program, and will need to find the right resistance so that yo can complete between 10-15 repetitions for 2 – 3 sets of each of the 6 exercises.

The program’s routine will need to be performed 3 times per week and consists of the following 6 exercises with pictures and written instructions:

Thera-Band Shoulder Adduction
Thera-Band Shoulder Extension
Thera-Band Shoulder Internal Rotation at 0 degrees
Thera-Band Shoulder External Rotation at 0 degrees
Thera-Band Shoulder Flexion to 90 degrees
Thera-Band Shoulder Abduction to 90 degrees

Rotator Cuff Strengthening: Home Program

Get the AAOS Rotator Cuff Conditioning Program PDF DownloadThis PDF includes images and instructions for 8 at home rotator cuff strengthening exercises.

Standing Rows
External Rotation
Internal Rotation
Standing Hitchiker
Bicep Curl
Tricep Press
Serratus Punch

Rotator Cuff Exercises to Avoid

  • Chest Exercises: Due to the mechanical leverage utilized during chest presses any barbell presses whether bench or incline require a heavy load directly on the shoulder and will likely make your rotator cuff injury worse. If you must continue chest exercises with a rotator cuff injury then avoid wide grip exercises, the wider the grip the more pressure on your shoulder. Also, when lowering the weight onto your chest, keep the weight down from your neck close to the middle of your chest, the higher up your body you place the weight, the more pressure on your shoulder.
  • Tricep Dips: Dips place vertical stress directly on your shoulder where your scapula and clavicle come together. This pressure can aggravate your rotator cuff pain.
  • Shoulder Exercises: Lateral raises or overhead presses, any movement where your arms are pulled away from your body outward and/or upward from 60 – 120 degrees will activate your supraspinatus and can aggravate your rotator cuff injury. If you must continue these exercises, cause say you are a competitive bodybuilder, then make sure to reduce the range of motion and lower the amount of weight in order to minimize aggravation to your injured shoulder muscles.

General Tips on Shoulder Exercises & Movements to Avoid

Avoid overhead arm positions on a repeated basis since it can cause shoulder pain. If you require to perform such activities due to the nature of work in your job, speak to a physical therapist so that he or she will teach you arm positions with less risk. Add scapular and rotator cuff muscle strengthening exercises to your workout regimen. Strengthening the rotator cuff muscles are extremely important similar to strengthening any other muscle group of the body. This is one of the best ways to prevent such injuries in the future.

Practicing good postures is important as well. Maintaining a forward position of the head and shoulders has proven to alter shoulder blade position and create shoulder impingement syndrome. Don’t sleep on your side with the arms stretched overhead. Lying on the shoulder should be avoided as much as possible. These positions can cause rotator cuff damage with time. Don’t carry heavy objects on your side. This will strain the cuff muscle. Smoking can decrease the blood flow to the rotator cuff muscle. Consult your physical therapist at the first signs of rotator cuff tear.

Rotator Cuff Exercise Youtube Videos

Here are some of the top rotator cuff exercise youtube videos from experts on treating rotator cuff injuries. Start with diagnosing the rotator cuff tear using the tips in the first video to identify the common signs of this injury, and once diagnosed use the exercises in the following two videos to treat and strengthen your injured and weakened rotator cuff muscles.

Diagnose your rotator cuff tear by learning the top 3 signs of a rotator cuff tear

Treat your rotator cuff tear with these top 3 exercises for a rotator cuff tear

After treatment, strengthen your rotator cuff muscles using these top 3 Rotator cuff strengthening exercises

Related: Rotator cuff exercises Kobe Bryant wishes he did this season.

Physical Therapy Apps for Rotator Cuff Treatment

PTs and PTAs use scientific names for muscles that patients don’t know and so visuals can be extremely helpful when educating patients on their injuries and how to rehab them properly. So, iPhone and iPad apps can be extremely helpful when working with patients that have rotator cuff tears as they offer animations, videos, and pictures that offer visuals alongside your discussion with your patients.

Here are some apps that you can use at your clinic to show your patients pictures and animations of the rotator cuff injuries they are experiencing. Some of these apps also have guides and videos that show how to perform the physical therapy exercises for rotator cuff tears and injuries. So, you can show your patients the app on your device at your clinic and suggest they download it to take home with them to perform their exercises.

Medical iRehab Shoulder Rotator Cuff

Medical iRehab Shoulder Rotator Cuff, By Reubro International is a great iPhone app with nearly a 5 star rating. The app provides an overview to all rotator cuff injuries including tendinitis and tears offering information on pain management and treatment. Over 40 rehab exercises for regaining range of motion, strengthening the damaged muscles, and increasing stability are all included in the app to facilitate a full recovery.

Shoulder Decide – Patient Engagement Tools for Healthcare Providers

Shoulder Decide – Patient Engagement Tools for Healthcare Providers, By Orca Health, Inc. is a powerful iPhone and iPad application that offers a patient engagement platform. This will allow PTs and PTAs to not only show patients information and exercises regarding their rotator cuff injury, but many other injuries as well. High quality images as well as 3d animations are included to help educate patients on their injuries. Strengthening, stretching, and dynamic exercises are all included for each injuries recovery as well and videos on performing the exercises can be watched right from within the app. This app is geared to help medical professionals provide better service and treatment for their patients results in a higher patient retention rate. The app has nearly a 5 star rating with almost 150 reviews.

Shoulder Pro III with Animations

Shoulder Pro III with Animations, By, LLC is an intuitive iPhone app that provides shoulder animations for explaining injuries and treatments to patients.

Are you a PT or PTA that has treated a patient who tore their rotator cuff? Tell us about your experience in the comments below! 🙂

Image By Nucleus Communications (Nucleus Communications [Attribution], via Wikimedia Commons

American Academy of Orthopaedic Surgeons (AAOS)

PerformanceHealth Academy – Theraband Academy

WebMD – Rotator Cuff at Home Treatment

Charles Thigpen, PhD, PT, ATC and Lane Bailey, PT, DPT @ MoveForwardPT

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