Rotator cuff tears are a normal part of aging, but pain isn’t inevitable

The first sign that retired accountant Kathey Parcels had torn her left rotator cuff was pain, sudden and acute pain.

“It was really bad,” said Parcels, who experienced the injury three years ago when she was 73. “You couldn’t sleep or lean on it. You couldn’t lift things up.”

She blames her injury on the hours she spent with arms overhead while winterizing her windows with shrink wrap and putting a temporary cover over a hole in her bathroom ceiling, the result of an upstairs neighbor’s burst pipe.

But Northeastern experts in physical therapy and medicine say it’s likely that tears or other abnormalities were already present in her rotator cuffs as a normal part of aging.

While falls and other injuries can cause acute injury to the rotator cuff, most abnormalities are the result of everyday use of the muscles, said Jason Parente, associate clinical professor in medicine sciences and director of Northeastern’s physician assistant program.

“It’s a chronic process. It’s wear and tear with age,” said Parente, who added that he sees many patients with rotator cuff injuries at his job in the emergency room at Massachusetts General Hospital, and most of these patients are middle aged or over.

That doesn’t mean everybody will experience pain and loss of function, however. The time Parcels spent winterizing her home probably just created the right conditions for those tears to become injured and inflamed, researchers said.

The rotator cuff affects just about everything people do with their arm and shoulder, said David Nolan, an associate clinical professor in the department of physical therapy and rehabilitation sciences.

“Any time that you’re doing anything with your arm, especially anything overhead, the rotator cuff functions to allow that motion to happen at the shoulder,” said Nolan, who is also director of Northeastern’s sports physical therapy residency program.

But just what is the rotator cuff and are there things that we can do to prevent those tears from turning into a painful or debilitating injury?

Here’s what to know.

What is the rotator cuff?

The rotator cuff is actually a term for four small muscles that balance the head of the humerus, the long bone of the upper arm, in its shallow socket in the shoulder blade.

Think of the shoulder as a golf ball on a tee, said Eric Folmar, associate professor in the department of physical therapy, movement and rehabilitative sciences.

“The socket is very small, the ball itself is very large,” he said. The role of the rotator cuff is to manage “the ball on the tee to make sure it stays there at all times.”

The rotator cuff muscles are important even at rest, when they create just enough tension to keep the socket in the shoulder comfortable, Folmar said. “It causes tremendous pain if somebody has a rotator cuff injury. Day-to-day functionality is significantly disrupted.”

How common are injuries to the rotator cuff?

“If you do an MRI on people 40 years old, you’re going to see signs of wear and tear. You’ll probably see partial tearing,” at least, Folmar said.

Tears and partial tears to the rotator cuff are so common that physical therapists call them “wrinkles on the inside,” he said.

Luckily for most people, these tears and partial tears do not result in symptoms and can be ignored unless they get painful, he said.

“Age-related or degenerative fraying that would come up as an abnormal finding on an MRI (would) not necessarily cause any significant problem in day-to-day activity,” Nolan said.

What happens to make normal wear and tear more severe?

Folmar said the biggest threat to the rotator cuff muscles “is our day-to-day posture.”

The rounded shoulder posture of people on phones, computers, driving and watching TV can threaten the shoulder bone’s precise position in the socket and compromise the rotator cuff around it or pinch the rotator cuff muscles against a bone, he said.

Is there anything people can do to help prevent injury?

The muscles involved are so small, outright prevention “is tricky,” said Stephen B. Clark, an athletic trainer and assistant professor in the department of physical therapy, human movement and rehabilitative sciences.

It’s not like people can bench press their way to stronger rotator cuffs, especially since there are more than 20 other muscles in the shoulder blade area that play a role in keeping rotator cuffs functional, Nolan said.

The best thing people can do to keep their rotator cuffs in shape is to maintain a healthy, active lifestyle and keep blood flowing to tissues, Clark and Folmar said. Aging decreases oxygen availability and blood flow to the muscles, while a sedentary lifestyle slows circulation, both of which delay healing, they said.

It’s also important to manage conditions such as diabetes, which studies have shown can increase the likelihood of shoulder disorders, and high cholesterol, which has also been implicated as a risk factor in rotator cuff injuries, Parente said.

How might people use exercise for prevention?

If people want to try to exercise their rotator cuffs, Clark suggests using light weights of one to two pounds or light exercise bands with movements that focus on internal and external rotations.

Overexertion with heavy weights can actually lead to pain and injury to the rotator cuff, Northeastern experts said.

How is the condition treated?

Patients seen in the emergency room with rotator cuff pain may be given a sling for their arm, ice and anti-inflammatory medication, but their immediate next step should be to consult a physical therapist, Northeastern experts said.

The physical therapist can assess the patient’s movements and pain points to come up with an individual plan of exercises and possibly manual manipulation.

In addition to the rotator cuff muscles, there are more than 20 muscles that surround the shoulder blade area, which means that physical therapists have to be very specific in their treatments, Nolan said.

“The most important thing you can do with a patient is to hear what they’re talking about—how they describe their symptoms and what their complaints are,” Folmar said. He said clinicians prefer not to tie treatment to what they see on an MRI because they could end up treating things that actually are not bothering the patient.

Waiting too long to treat rotator cuff pain can lead to chronic tendinopathy and possibly permanent tissue damage. Parente said tendinopathy is the term now preferred over tendonitis, because most chronic tendon issues involve collagen degeneration, not inflammation.

Surgery is usually the option of last resort and is used for younger people who have sustained acute damage to their rotator cuffs through falls or sports injuries.

Parcels, who lives in Osterville, MA, said that she made an immediate appointment with her primary care physician after experiencing pain in her rotator cuff. A specialist she was referred to in Boston discovered a partial tear and recommended physical therapy.

She ended up with a physical therapist who had her doing exercises in a pool with water up to her shoulders.

“Doing this was like magic,” Parcels said. “If you have the right physical therapist (they will) get you to the right place.”

This story is republished courtesy of Northeastern Global News news.northeastern.edu.