Adam Mann Rotator Cuff Tear

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. They are multiple award winning Best Physiotherapists in Vancouver. If you want to get better, these are the guys to see, and we're going to talk about a rotator cuff tear. How are you doing Adam? 

Adam: Doing well. Good to see a Mark.

Mark: So what was going on with this client, we're going to tell a little bit of a history of a client. They came in with a rotator cuff. What did you see? 

Adam: Yeah, so this guy was a middle-age plumber. And so he used his right arm a whole bunch just to tighten valves and all sorts of stuff in sort of really tight spots.

So he's always kind of reaching under and kind of doing some end range motions, a lot of twisting motions. So he had pretty debilitating shoulder pain and it was going on for almost three to four months. And it was on the front part of his arm right here. And he felt like his arm was painful. It was weak and it had limited range of motion. And it's this guy's livelihood. So he definitely needed his arm to be rock solid. 

So eventually we assessed him and we decided that he had a rotator cuff tear. 

Mark: So how did that present? Like what other issues was he having other than just the pain that of maybe trying to do, you know, look after plum juice, but what else was happening with in his life?

Adam: So, you know, he had a lot of pain when he was sleeping. That was a big part of it. So when he's sleeping on that side, or even on the other side, and his arm was in a non ideal position, you would just feel that kind of achy pain. He also would feel a pinch as soon as he kind of was reaching overhead past 90 degrees and almost any motion. And sometimes the pain would actually radiate a little bit to the back. 

Mark: So how do you assess and treat this condition? 

Adam: So shoulders are really interesting to treat. So typically when we do a shoulder assessment, we go in and we look at the neck range of motion. And we look at the shoulder range of motion, and then we also look at the shoulder blade. And so here's a shoulder blade here that I have, and there's 17 muscles that attach to the shoulder plate. And some of them go all the way up to the neck wrap around to the front of the arm and the rotator cuff in particular, its job is to stabilize this ball and socket joint. So as he's moving his arm through different ranges of motion, it sort of adds a bit of compression onto the joint so that he can move above 90 and do something, those extreme motions.

But the way that we look at it is we will take a look at the neck. We'll make sure that we'll look at the posture. That's actually a really big part of it because a lot of times the tendon that was compressed, if the shoulder is in a forward posture position, this tendon here is the one that he damaged, it's called the superspinatus.

So in certain positions, it can get compressed when you're in a bad posture position. So we could confirm some of that with do some strength testing and orthopedic testing, and basically a cluster of different tests that show that it was a rotator cuff tear. And so that's how we kind of assess it.

Mark: And so then how do you move into treatment of that, given that it's a tendon and it's within a joint that he's going to be using a lot. 

Adam: In terms of treatment again, because there's so many different factors in the shoulder. I always like to start with posture.

So we really try to get that shoulder blade into a better position. And we do that by treating a bit of the neck where we open up the neck. We make sure that the back muscles bring the shoulder blade into an ideal position are working. And then we add in a gradual strengthening program of the shoulder and we start in pain-free ranges.

So we might start below 90 at first, and then we'll slowly creep up to higher motions or end range motions. Once we have more real estate that's pain-free inside of that joint for the person to move. 

Mark: So that sounds like a very holistic kind of body approach. What can you tell me more about that? How does that work? 

Adam: Yeah, so in general, the way I treat and the way I look at a person is force goes to the area of least resistance. And so if it's going into this muscle here, it's probably due to a dysfunction of where that shoulder is sitting. And so if we can get that shoulder into a better position, we're gonna have lasting outcomes.

And the problem with rotator cuff tears is that 50% shoulder pain tends to come back. So when we are treating this, I kind of set realistic expectations with the client where we can get you pain-free and we can probably get you full range of motion back, but you do need you to keep up with some of the exercises that we give you. Not all of the exercises, but some of them, you know, once a week, like you can miss a couple of days here and there for sure, but I wouldn't miss a couple of weeks.

Mark: And so that kind of falls onto the next question. Would this just go away all by itself?

Adam: A lot of research shows that this doesn't necessarily go away. It does come back a fair bit. And in general, working on posture is quite healthy. We want to get people moving well for long periods of time.

And so, it would probably ebb and flow, but the shoulder would still be weak. We actually do need to strengthen the muscle and the tendon that was compressed, in order to get full function back. And there was a bit of research that shows if you don't rehab it and get it stronger, it will actually lead to arthritis inside of the joint and stuff like that later on. And some other outcomes that we don't want.

Mark: So there you go, if you've got pain in your shoulders and you want it fixed and you want it to not come back and continually make your sleeping really difficult. I've been through this. This is not fun at all. And I was treated at Insync and it made a heck of a difference and it will work for you. You can reach them. Insyncphysio.com to book online.

You can talk to Adam in Vancouver office at (604) 566-9716 to book and get him to look after your shoulders for good. So that you can live out the rest of your days with healthy, loose shoulders. Thanks Adam. 

Adam: Awesome, Mark. Glad to hear that your shoulder's moving better. Good chatting with you.