Hey hi I'm Bob from physical therapist
and I'm Brad and a physical therapy and
together we have the most famous
physical therapist on the internet and
about painter of course and we get this
question a lot yes I have a rotator cuff
tear or injury and they want to know
what can it heal they want to know is it
going to get better can it you know can
actually get better without search or
sure so that's what we're gonna talk
about today you do I think need to have
this basic understanding of why you
injure your rotator cuff in most cases
in the first place right so your rotator
cuff is made up of four muscles and the
floor muscles are around the shoulder
and you have basically a ball and a
socket and the muscles especially some
of the muscle on the top comes through
this gap here you're gonna show that
right there the supraspinatus is the
most commonly injured rotator cuff
muscle the belly the muscle is actually
back up here and the back part is your
older and the tendon goes right through
here when my pen goes underneath the
acromion part of your shoulder blade and
then it wraps around and it connects up
to here and yeah I need to get pinched
there so y'all get pinched and if it's
getting pinched eventually it'll start
to fray right it's like a rope starts to
fray yeah look like lobster meat after
sure so let's get rid of the pulley now
so this represents your shoulder and
this represents the acromion and the
promeo clavicular ligament now this is a
nice healthy gap deer bread so there's
plenty of room for that ligament to go
through here right and the muscle but
let's say there isn't let's say this is
narrow it out and you've got just barely
any room here now in this case that's
where you're gonna get the pinchy
and the impingement and it's gonna start
to fray right now with therapy what
we're trying to do is increase that gap
and we can do that a number of ways and
we do it through strengthening the
shoulder and and even just some manual
manipulation mobilizations yeah
mobilizations we don't do manipulation
so the question is can that heal and the
answer is yes in fact right you said you
do a study right right there is a study
that came out 2013 and the journal of
shoulder and elbow surgery they have 422
patients and the bottom line is after 2
years 75% of them did not have surgery
and became functional we can't say they
tendon healed up
but we know it became functional they
did not eat three out of four people got
function back in their shoulder you know
the thing is you can get a tear in the
shoulder in the tendon it can be a
partial thickness tear which means it
doesn't even go all the way through
right or it can even go all the way
through but it might be up just a
pinnable or a buttonhole the shoulder
and the rotator cuff turnaround bob once
so this is a bob shoulder blade which is
right here and this is this humerus
which is a bone here and these muscles
that we took off his skin and all that
fat around him we can see his big
muscles right here and the rotator cuff
muscles are actually attached to your
shoulder blade this is your super
infraspinatus finatus yeah here's Alerus
yep subscapularis and everything on
teres minor yeah sorry I mean I'm under
pressure with Anatomy terminology but
here's that supraspinatus most common
one that bob was talking about and here
is he it's a broad ligament and there's
a and that's where the tear would occur
yeah and you can see if this is being
pinched well see there swimmer you were
overhead a lot with it it's working up
in this getting pinched into this bone
it won't be a complete rupture but it
will wear through in one spot
exactly like surah Tauba could be just a
pinhole or it could be as big as a
buttons size and there is in rare
occasions it actually detaches
completely and in that case I don't know
how you can get away from surgery unless
all the other muscles come in and help
out and take all right so I think that's
a case in trauma where you know severe
accident and it just pulls it right off
but these things that come on gradually
gradually pain oh I start I think about
six months ago right and now I can
hardly reach and recovered those are the
injuries take take heart in knowing that
yes should we have a rotator cuff a
treat and or tear that in three out of
four cases people have good results from
it so I would give a therapy a try you
can always have the surgery breath right
right and you need to make this decision
all right a dog I've got a woman right
now she's 22 years old she works in a
skilled nursing facility and she's got
shoulder pain they had MRI and yes this
you got two tears in that partial tears
they're not gonna have surgery she
didn't have surgery the doctor said
let's go conservative and actually once
we started she was doing this kind of
did look like a complete Lobster now or
four weeks later she's already up to 90
degrees
pain is dramatically allowed his Hannah
the exact same situation Brad lady came
in full thickness tear I thought she's
not going to do well she was really
hurting for a long time and now she's up
here right and she did fantastic so and
this is mostly with home exercise right
the therapist guides you along tells you
what to do or not to do do your homework
and you're gonna get better you need to
do your exercises and listen to your
therapist yes and some super bright
subscribe to us because we'll help you
love we've got lots of you and your
finish line all right
thanks a lot