Rotator cuff shoulder injuries are a pain. Yes, they are. They are notoriously problematic, slow healing and painful. They negatively affect activities of daily living like reaching for things, playing sports like golf and tennis, and sleeping. Most people report pain lifting their arm above their head, reaching behind your back, and taking your arm to the side of your body. Sleeping can be a nightmare. Many patients report difficulty sleeping and disrupted sleep, especially trying to sleep on the bad side or when turning onto the bad side.

Rotator cuff injuries are very common. A high proportion of the over-80s have them, sometimes without even knowing. This helps us with the causative factors – we know that in many cases, rotator cuff tears are degenerative. This means that the tendon weakens over many decades and eventually can tear from sometimes menial activities.

Let’s look briefly at the types of tears: there are broadly three types.

• Partial thickness rotator cuff tear (the tear goes partially through the width of the tendon).
• Full thickness rotator cuff tear (the tear goes fully through the tendon).
• Rotator cuff rupture (the whole tendon has split and is not joined – this is the most severe form of tear).

We also see similarities in the rotator cuff affected. In most cases, the supraspinatus rotator cuff tendon is the most commonly affected. However, there are three other rotator cuff tendons that can be torn but far less commonly, namely infraspinatus, subscapularis and teres minor.

Let’s look at the five best ways to help with the pain:

1. Physiotherapy and Osteopathy

Yes, we know we’re playing our own instrument here, but physiotherapy and osteopathy really are fantastic ways to improve strength, mobility, and reduce pain and inflammation. We do many of these articles, and we don’t always recommend therapy. However, rotator cuff problems are very complicated and problematic and physiotherapy and osteopathy can significantly help. The key problem is usually the stiffness and/or weakness. We can help you regain mobility. We know from many research papers including a big study in The Lancet that physiotherapy is as successful as surgery for rotator cuff tears.

2. Exercises

Exercises can often help. Just make sure you are doing the right ones. It’s not necessarily always about strengthen strengthen strengthen! Sometimes you need to regain mobility. There are also stability exercises which are just as important as strengthening exercises. There are also functional exercises to help you get back to sport or daily living. There’s more to exercises than first meets the eye, and so consulting with a therapist to be guided with the right exercises for you at this point is important.

3. Steroid Injection

We do perform steroid injections. There is debate around having a steroid injection for rotator cuff tears, as there are some mild risks that tendon tears can occur. However, the tendon is likely already torn. The steroid is used to reduce pain and inflammation. Do we do steroid injections on everyone? Absolutely not, we prefer a less invasive approach first. If you’ve tried therapy and exercises and you are not going anywhere, then a steroid injection is a good next step to hopefully avoid surgery if we go through a shared decision-making process with you, and what you want to happen.

4. Surgery

Surgery has mixed results. Sometimes people do amazingly well, but sometimes they struggle. Rehab following rotator cuff surgery is often nine months, and can be one year. The surgery will help double-row the tendon together. This should prevent further tears. However, bear in mind that the tendon is likely to be degenerate and the tendon can re-tear following surgery, especially in the first 4-6 weeks. When we go through a shared decision-making process with our patient about surgery, we often find that people just don’t like the thought of the tendon being torn and want to get it put back together. We understand that, and support your decision on it. We obviously prefer to offer rehab rather than surgery, but we know surgery does have its place and can be very helpful. However, our suggestion is to try rehab first.

5. Ice

Applying ice is a great way to reduce pain. This can help give you confidence to gently start moving your shoulder. Wrap an ice back with a tea towel and apply for ten minutes per day over the tip of the shoulder. Ice is a useful pain-reliever. Heat can also help too, and a hot water bottle for ten minutes can be helpful too.

There are lots of other things that can help reduce pain. Medications are useful for pain relief, e.g. anti-inflammatories. Acupuncture and shockwave may help too. Quite a few patients report acupuncture as providing pain relief following rotator cuff tears. Being generally fit, well and healthy and sleeping well is also important. And your own psychology and view on pain. Some people are more sensitised and focus more on their pain.

If you need one of our amazing team of physios or osteopaths, please don’t hesitate to reach out by booking online or calling us on 0208 685 6930