As people get older, it’s normal for them to think that their body is ‘falling apart’. A common scenario is waking up one morning with shoulder pain (and no recollection of any particular event that could have caused it), going to the doctor and getting an ultrasound or MRI, only to discover (**horror of horrors!**) that you have a rotator cuff tear. This naturally makes most people concerned about whether or not they need surgery…
SPOILER ALERT!: Even with a full-thickness tear, it’s been shown that physiotherapy and conservative treatment can rehabilitate your shoulder and get you back to your daily activities (1). It’s only WHEN you have multiple (at least 3) tendons affected with “massive” full-thickness tears that conservative management is less likely to succeed and you may require surgery (2).
In fact, rotator cuff tears are so common (even in the asymptomatic population (ie PAIN-FREE)), that they are now starting to be considered part of the natural aging process (3). The prevalence of rotator cuff tears increases as we get older – up to 10% by age 20, 30% by age 60, and 60% after age 80 (3,4,5).
The size of the tear also does not correlate very well with pain intensity or function (6, 7, 8, 9). ie Someone with a larger tear may have minimal/no pain and good overhead motion while someone else with a smaller tear may have lots of pain and limited motion. Instead, higher pain levels and reduced function have been related more to comorbidities (such as diabetes or hypertension/high blood pressure) (6, 7), poorer mental health (6), weaker shoulder muscles (9), and poor shoulder blade control (9).
That’s where physiotherapy comes in – we can help you:
manage your specific comorbidities with appropriate aerobic activities and resistance training (10)
learn to cope with stress through physical activity, proper sleep hygiene, and return to participating in fun, recreational activities
strengthen your shoulder and regain control/awareness of your shoulder blade
We can also give you tips and tricks to manage your shoulder pain!
Thanks to ‘Father Time’, aging is inevitable…there’s no denying that tissues get stiffer and lose absolute maximal capacity as we age (11). The key to aging gracefully is learning to live with and accept those grey hairs and wrinkles. Perhaps in time, we can let those (both internal AND external) ‘grey hairs’ even bring a sense of pride in everything we’ve accomplished in our lives!
As my vivacious 75-year-old mother loves to say, “growing older is mandatory…growing up is optional!”.
For more information about rotator cuff tears, aging, and/or help making an exercise plan that is right for you, contact InReach Physio.
By: Susan Herdman, Registered Physiotherapist
Book a telephysio / online physio / virtual physio / video physiotherapy appointment with a registered physiotherapist in British Columbia. InReach Online Physio services communities in northern and rural BC, such as Masset, Queen Charlotte, Fraser Lake, Fort Nelson, Fort St James, Dease Lake, Fort St John, Dawson Creek, the Gulf Islands, and more!
REFERENCES:
Boorman RS, More KD, Hollinshead RM, Wiley JP, Mohtadi NG, Lo IKY, Brett KR. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018 Mar;27(3):444-448. doi: 10.1016/j.jse.2017.10.009. PMID: 29433644. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/29433644/
Collin PG, Gain S, Nguyen Huu F, Lädermann A. Is rehabilitation effective in massive rotator cuff tears? Orthop Traumatol Surg Res. 2015 Jun;101(4 Suppl):S203-5. doi: 10.1016/j.otsr.2015.03.001. Epub 2015 Apr 15. PMID: 25890809. Accessed May 17/22:https://pubmed.ncbi.nlm.nih.gov/25890809/
Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. PMID: 25441568. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/25441568/
Prabhakar A, Kanthalu Subramanian JN, Swathikaa P, Kumareswaran SI, Subramanian KN. Current concepts on management of cuff tear. J Clin Orthop Trauma. 2022 Feb 18;28:101808. doi: 10.1016/j.jcot.2022.101808. PMID: 35402155; PMCID: PMC8983388. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/35402155/
Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K, Kijima H, Itoi E. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013 Feb 26;10(1):8-12. doi: 10.1016/j.jor.2013.01.008. PMID: 24403741; PMCID: PMC3768248. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/24403741/
Wylie JD, Suter T, Potter MQ, Granger EK, Tashjian RZ. Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. J Bone Joint Surg Am. 2016 Feb 17;98(4):251-6. doi: 10.2106/JBJS.O.00444. PMID: 26888672. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/26888672/
Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway GB, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW. Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am. 2014 May 21;96(10):793-800. doi: 10.2106/JBJS.L.01304. PMID: 24875019; PMCID: PMC4018774. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/24875019/
Gill TK, Shanahan EM, Allison D, Alcorn D, & Hill CL. Prevalence of abnormalities on shoulder MRI insymptomatic and asymptomatic older adults. Int J Rheumatic Diseases. 2014; 17:863-871. Accessed May 17/22: https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185X.12476
Harris JD, Pedroza A, Jones GL; MOON (Multicenter Orthopedic Outcomes Network) Shoulder Group. Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med. 2012 Feb;40(2):359-66. doi: 10.1177/0363546511426003. Epub 2011 Nov 17. PMID: 22095706; PMCID: PMC3632074. Accessed May 17/22: https://pubmed.ncbi.nlm.nih.gov/22095706/
Canadian Diabetes Association. Website: Managing my diabetes/Preventing Complications/High blood pressure. Accessed May 17/22: https://www.diabetes.ca/managing-my-diabetes/preventing-complications/high-blood-pressure
Brooks, GA, Fahey TD, & Baldwin KM (2005). In Exercise Physiology: Human Bioenergetics and Its Applications 4th Ed – Chapter 32: Aging and Exercise (p 834-851). McGraw Hill, New York, NY.