Title – Rotator cuff tear: a case study
Rotator cuff tears are quite common and something we see quite frequently. The important thing to identify is the severity of the tear and the location. As the rotator cuff muscles are muscles of stabilisation these are most commonly the muscles affected in trauma cases. To learn more about the rotator cuff follow this link to my blog on the rotator cuff.
What is a rotator cuff tear and how does a tear happen?
A tear is literally a tear in one or more muscles of the rotator cuff. This can be in the muscle itself or in the tendon (this connects the muscle to the bone). A tear may also be referred to as a strain or pulled muscle. These tears are graded based on their severity and we have seen all of these in our chiropractic clinic in Eastbourne.
Grade 1: Mild damage to individual muscle fibres with limited loss of strength and movement
Grade 2: Greater damage to a larger proportion of muscle fibres with significant loss of strength and movement
Grade 3: Complete rupture of the muscle or tendon
Rotator cuff tears are often due to trauma or fast quick movements. I have seen many in my time in practice from falls directly on the shoulder or onto the elbow or hand; to throwing a ball or picking something heavy up quickly.
A case study
This case is of a seventy-year old woman who was an existing chiropractic guest of mine at Lushington Chiropractic clinic in Eastbourne. She had never had any issues with her shoulder but twisted her ankle causing her to fall forwards. She landed on her left hand as she put her arm out to stop her fall. This caused immediate severe pain in her left shoulder.
I saw her the next day and her range of movement in her shoulder was severely reduced with pain in all movements. Testing was performed to rule out fracture and advice on ice and basic exercises were given.
Treatment then consisted of soft tissue work around the shoulder and work into the neck and upper back. Pain in the shoulder gradually decreased and range of movement began to improve. Testing was repeated regularly to check progress, and all seemed to be improving well apart from a couple of areas.
At this stage I decided to refer her on for an ultrasound of her shoulder to assess the cuff . I suspected that we had had a complete rupture of at least one of her tendons.
An ultrasound is best to assess the integrity of the tendons and check for the extent of injury. Following her ultrasound, we found that she had completely torn her Supraspinatus and Subscapularis tendons. In these cases, surgery for repair is an option but there is a significant chance of re-rupture (the tendon tearing again).
After speaking to a surgeon in Eastbourne he did not recommend treatment as he felt the risk of re-rupture was too high.
With continued chiropractic treatment she has now got a near full range of movement, but the left arm is still weaker than the right. This is common following full thickness tendon tears in the rotator cuff, but she is continuing with exercises to improve this.
These results are the best we could have really hoped for in a seventy-year old woman with this level of injury.
This case shows that even with a rupture of two tendons within the rotator cuff the shoulder can recover and adapt, but her left shoulder will never be as strong as the right. This demonstrates just how important the rotator cuff is in how strong and stable the shoulder is.
Want to find out more about Shoulder pain and the RC?
If you’ve enjoyed this blog and want to find out more about shoulder pain and the rotator cuff, then please check out one of our other blogs on the shoulder joint below.
Yours in health,
Mykel Mason your Eastbourne Chiropractor
By Mykel Mason
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