What is a rotator cuff strain?
A rotator cuff strain involves a tear or partial tearing of one or more of the rotator cuff muscles causing pain in and around the shoulder. The rotator cuff muscles are made up of 4 individual muscles, the supraspinatus, infraspinatus, subscapularis and teres minor muscle. The rotator cuff muscles are a group of muscles that originate from the front and back of the scapula (shoulder blade) and insert along the upper portion of the humerus. The rotator cuff muscles support and stabilise the shoulder joint, hugging the humeral head into place. The rotator cuff muscles are also responsible for most shoulder movements in particular rotation (twisting the arm from palm and elbow up to palm and elbow facing downwards) and elevation (Lifting the arm up towards the ceiling). A rotator cuff strain typically involves tearing of the supraspinatus muscle.
What is a muscle strain?
A muscle strain commonly known as a pulled muscle is a medical term used when a muscle or tendon has been injured by a sudden powerful contraction or from overuse resulting in small tears within the muscle fibres or tendon itself. Each muscle is made up of thousands of small fibres that have a powerful elastic property that allows it to stretch and be flexible yet strong. The muscle fibres are in what we class the muscle belly and they all converge to one point and are connected to the bone by a very strong tendon which looks similar to a cord or piece of string. General muscle pain is normally pain from the disruption of the small muscle fibres either through mild injury like repetitive movements, tightness or inflammation. A muscle strain results from sudden or excessive tension being placed through the muscle fibres causing small tears. Milder injuries to the muscles tendons are covered under the condition tendonitis. Muscle strains are graded by their severity
Grade I- This is where only a small number of muscle fibres are torn resulting in pain and discomfort but not affecting the muscle function or movement.
Grade II- This is a partial tear where a substantial number of muscle fibres are torn resulting in slight loss of muscle function and movement.
Grade III- This is a complete tear where all the muscle fibres are ruptured resulting in a complete loss of muscle function and movement.
Strain injuries are commonly confused with sprains. The injury is very similar but a sprain affects the ligaments not the muscle or tendon.
Why and when does a rotator cuff strain happen?
A rotator cuff strain is a common injury and effects people of all ages. It is often seen in individuals who partake in a lot of throwing sports in particular javelin throwing, cricket and tennis. Other sports like swimming, canoeing and weight lifting also place an increased load through the rotator cuff muscles commonly resulting in a strain. Rotator cuff strains commonly occur due to a sudden contraction or overstretching of one or more of the rotator cuff muscles. This frequently occurs when an athlete attempts to lift a large weight or an explosive throw. Occasionally a strain will occur due to gradual wear and tear of the muscle, this is associated with overuse. Overuse may be due to activities such as repetitive work tasks, like cleaning or lifting heavy objects, working with arms stretch overhead or strong pulling and pushing activities. Injuries are also more likely to occur when the rotator cuff muscles are tight and weakened from a combination of overuse and lack of stretching.
What does a rotator cuff strain feel like?
A rotator cuff strain begins as a sudden sharp burning pain, initially concentrated in and around the shoulder. The specific location of the pain will depend on which muscle belly the strain affects. The pain often travels from the shoulder into the mid back and neck. In more severe cases a tearing or snapping noise is heard during the injury. In these instances the strain will mean that the individual or athlete is unable to continue. With milder strains or partial tears the pain will be mild and the individual or athlete may be able to continue through the activity. The tear or rupture will be accompanied by severe swelling and bruising that will be incredibly tender to touch. In cases of rupture there will possibly be a reduced ability to raise the arm above shoulder height. Pain levels will be aggravated by most shoulder movements making lifting, pushing, pulling or simply holding the arm out in front of the body excruciating and impossible in cases of a full rupture. In partial tear cases, patients can still fully use their shoulder with stiffness and a feeling of discomfort whilst lifting or throwing. Once healing has started the severe pain will be replaced with dull aches and discomfort felt when the rotator cuff muscles are stressed. Stiffness and dull aches are normally experienced during the night and most intense early in the mornings making sleeping incredibly difficult. Residual levels of stiffness and pain can be felt around the mid back and neck due to immobility, tightened muscles and the strain of wearing a sling.
How long does a rotator cuff strain or tear take to heal?
A mild rotator cuff strain can recover relatively fast, normally between 1-3 weeks. The healing time varies dramatically depending on the severity of the strain, with most muscle tears the healing time ranges from 1-2 months and in some cases as long as 3 months. However complete muscle tears take much longer to heal and almost always need surgical intervention. Post-surgery a sling may be used and the patient may be instructed to rest the shoulder for up to two months followed by up to 6 months’ worth of physical rehabilitation, a full recovery to the original muscles strength can take up to a year.
How is a rotator cuff strain diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm the diagnosis however occasionally an ultrasound or MRI will be used to evaluate the extent of the tear or rupture.
What treatment options are available for a rotator cuff strain?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. Initially you will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves Resting your shoulder, try not to use it too much and most importantly to avoid all aggravating movements. Ice the area by applying a covered ice pack, this may significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your arm in a sling across your body to take the weight of the shoulder and to help limit the swelling.
Your doctor or therapist will evaluate the extent of the tear or rupture. If the strain is mild then you may just be instructed to rest and avoid any aggravating movements for a couple of weeks. In cases where using the arm is painful a sling may be provided. Once it is no longer painful, you should try to gradually return to full use of the shoulder using muscle stretches to help. Stretches should be avoided if they aggravate pain levels. Once you are using the shoulder pain free then you should focus on strengthening the rotator cuff muscles which will have atrophied and weakened after the injury and rest period. Your therapist or rehabilitation trainer will be able to provide you with the correct exercises, which will be mild and may involve resistance bands. Once the affected rotator cuff muscle is as strong as the other side then you can reintroduce any activities or sports that were previously painful.
Using sports or athletic tape whilst training can also help to prevent further strains and help relieve any discomfort and pain once a strain has occurred. The rotator cuff muscles can be taped individually but are normally taped as a unit connecting the scapula, shoulder and upper arm. Many sports therapists, physiotherapists, chiropractors and osteopaths can apply sports tape but you can also buy pre-cut strips and use the many online videos to help you apply them correctly (see our products section below).
If the rotator cuff muscle is partially torn then a sling will be provided and you will be ordered to rest for as long as the healing process takes. In cases of a complete muscle rupture, surgery is almost always necessary and is the best form of treatment to return the muscle back to original function and strength. The surgery will stitch the muscle back together, after this a cast/sling will be applied and you will be instructed to rest for 2 months at which point you will be referred through to a physiotherapist who will provide you with strengthening exercises for the shoulder muscles. Full strength recovery is not guaranteed and can occasionally take well over 6 months to achieve. A good rehabilitation program can aid the healing process and prevent reoccurring injury.
Once into the later phase of recovery many people find massage therapy helpful to loosen the affected muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the shoulder, mid back and neck working to reduce any stiffness levels caused from using a sling and help return the joints back to their normal movement.