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Rotator cuff syndrome

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What is rotator cuff syndrome?

Rotator cuff syndrome describes the pain and reduced function that some people experience in their shoulders that originates from the rotator cuff tendons. 

The rotator cuff are a group of tendons and muscles around the shoulder. Their main job is to control the position of the ball in the socket. A normally functioning rotator cuff allows for good movement of the arm and strength when working overhead or away from the body.

Patients with this problem usually have some evidence of tendon 'wear' which presents clinically as pain or weakness. On ultrasound scan these areas of wear are referred to as rotator cuff 'tears'.  The term 'tear' is slightly misleading as it suggests a sudden causative event rather than a gradual process but in any event it is refers to holes of varying degrees of thickness that develop through the rotator cuff tendons (usually supraspinatus) in the absence of significant trauma. 

The development of rotator cuff tears appears to be most strongly linked to age rather than any other factor, with 10 percent of people in their 60's and 20 pecent of people in their 70's having a rotator cuff tear.

In the past healthcare practitioners have put alot of emphasis on the presence of a tear and have linked this directly as the 'cause' of symptoms. In fact there is an extensive body of research which shows rotator cuff tears in people with no symptoms.This makes attributing pain in the shoulder to purely the presence of the tear problematic, and in fact we know that this isn't the full story, with lifestyle and useage patterns being important in the development of symptoms.

Furthermore recent studies have confirmed that there is no link between size and type of tear with clinical symptoms or outcome. This means that even people with large sized tears can get good outcomes with rehabilitation.

What is the treatment for rotator cuff syndrome?

We will usually suggest a trial of physiotherapy to try and resolve your symptoms without the need for surgery. Physiotherapy for rotator cuff syndrome is exercise based and  is based on a collaborative peice of research from an American shoulder special interest group called the Moon Group. You can view the full protocol here. The protocol has been tested in the US quite extensively and seem to settle symptoms for about 70 percent of people with rotator cuff syndrome.

Below are some early exercises from the programme. We would encourage you to try some exercises for your shoulder as sometimes some gentle mobility and muscle recruitment work is enough to settle things. We also offer class- based rehabilitation exercise groups for the problem, if you would like to get involved in one of these discuss an MSK referral with your GP.

Range of motion

 

 

 

 

Rotator cuff recruitment

 

 

 

Anterior deltoid recruitment

 

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What if the rehab programme doesn't work?

 

We recommend giving your shoulder 6 months of exercise before considering surgical management. If your symptoms do not settle satisfactorily over this period we can arrange for you to see one of our Extended Scope Practitioners who will be able to arrange the appropriate tests and investigations to see if surgery is a viable option for you.

Quick Links

Rotator cuff downloadable/printable version

Accompanying Moon Group patient exercise pamphlet

(If you are a GP printing off for your patient please supply with both leaflets)