¿Cómo afrontar un desgarro del manguito de los rotadores? Siéntete mejor con estos consejos y ejercicios

Si te han dicho que tienes una "rotura del manguito de los rotadores", no pasa nada por alarmarse un poco. Oír que te has desgarrado algo en el cuerpo puede dar un poco de miedo. Pero que no cunda el pánico: Un desgarro del manguito de los rotadores no es más que el nombre de una lesión del manguito de los rotadores, que es un grupo de músculos y tendones que rodean la articulación del hombro. 

Los desgarros del manguito de los rotadores son frecuentes, sobre todo a medida que envejeces. Y, en unos dos tercios de los casos, son completamente asintomáticos, lo que significa que la gente ni siquiera sabe que los tiene porque no les causan ningún dolor.

En muchos casos, puedes tratar una rotura del manguito de los rotadores con terapia de ejercicio y cuidados conservadores en Inicio. Y normalmente podrás reanudar tus actividades habituales en un plazo de seis a doce semanas, dice Julianne Payton, PT, DPT, fisioterapeuta de Hinge Health. Aun así, es importante que te mantengas activo con ejercicios del manguito de los rotadores mientras te recuperas, para que puedas mantener la articulación del hombro flexible y móvil. Si el dolor persiste tras el tratamiento o si el desgarro es consecuencia de una lesión aguda, la cirugía puede ser el siguiente paso adecuado.

Aquí puedes obtener más información sobre las causas del dolor de hombro y cómo prevenirlo y tratarlo, especialmente con ejercicios de los fisioterapeutas de Hinge Health.

What Is the Rotator Cuff?

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone. The shoulder is referred to as a ball-and-socket joint because the head of the humerus fits into the socket of the scapula. 

The rotator cuff is made up of four muscles and tendons that originate from the shoulder blade and attach to the head of the humerus, forming a "cuff" around it. This structure enables the arm to move in multiple directions, allowing for various arm motions such as lifting, pushing, and rotating, all while keeping the shoulder joint in place.

“Your rotator cuff muscles work together to move your arms overhead, out to the side, and behind you, and they help you rotate your shoulders as well,” explains Dr. Payton.

What Is a Rotator Cuff Tear?

A rotator cuff tear is simply a tear in one of the rotator cuff tendons. There are two main kinds:

• Partial tear. The tendon has a tear, but the tear does not include the full thickness of the tendon.

• Full-thickness tear. In this case, the full thickness of the tendon is torn.  

Symptoms of a Rotator Cuff Tear

If a tear is due to a sudden injury, you may experience intense pain and weakness in your upper arm. But if it’s due to overuse — the more common cause — symptoms can develop slowly, notes Dr. Payton. Common rotator cuff tear symptoms include:

• Pain in your shoulder when you lift your arm. “At first, it’s mild and you may notice it only when you lift your arm overhead,” explains Dr. Payton. “But over time, you may notice it even when you’re not doing anything, or when you’re lying on the shoulder at night.”

• Arm weakness. It may be hard to do daily activities, like reaching into a cupboard, combing your hair, or lifting something.

• Crepitus, or a crackling noise and sensation, when you move your shoulder.

Rotator Cuff Tear: A Hinge Health Perspective

If you have a rotator cuff tear, you may think you need to bandage up your shoulder and not use it until you heal. Nothing could be further from the truth. “I tell my patients that the rotator cuff is like a sock that fits around your shoulder,” explains Dr. Payton. “If you have a small tear in your sock, it’s still useful. You don’t have to throw it out.” The exact same thing is true for a rotator cuff tear. “If there’s a tear in one area, your other shoulder muscles can work together to compensate while you heal,” she adds.

That’s where physical therapy comes in. “A rotator cuff tear can be very painful initially, so you may be tempted to avoid movement, but that isn’t ideal for musculoskeletal and joint health,” says Dr. Payton. A physical therapist can work with you on gentle, assisted exercises to help your shoulder move. “The goal is to relieve pain, and increase shoulder function,” explains Dr. Payton. “If we build up strength around the whole shoulder itself, as well as the rotator cuff, you’ll be able to use your shoulder normally.”

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Rotator Cuff Tear Causes

Rotator cuff tears are often the result of normal, age-related changes, says Dr. Payton. “Our movement habits can change as we age, often leading to less activity,” she explains. “When you do less, there’s less blood flow to your rotator cuff muscles and tendons. This makes it harder for your body to keep these tendons and muscles strong and resilient, which can contribute to a tear.”

But age isn't the only thing that can contribute to a rotator cuff tear. Other common rotator cuff causes include:

• Specific sports. People who play sports that require a lot of overhead motions, such as tennis, baseball, and rowing, are more likely to develop tears over time.

• Certain occupations. If your job requires a lot of overhead work — like being a painter or a carpenter — you may be more at risk.

• Other medical conditions. Research suggests people who have high blood pressure or type 2 diabetes may be more likely to develop a tear, most likely because of less blood flow to the area.

• Smoking. This habit can also make you more likely to develop a tear, most likely because of impeded blood flow.

• Shoulder Injury. If you have a bad fall, or other trauma to your shoulder, you can tear your rotator cuff. “We usually see this in younger patients,” explains Dr. Payton.

Treatment Options

If you have a rotator cuff tear, it’s important to get treatment. While a tear won’t heal on its own, there’s a lot you can do to relieve pain and restore strength to the affected shoulder, says Dr. Payton. Here are the rotator cuff treatments Hinge Health physical therapists recommend:

Physical therapy. This is the mainstay of rotator cuff treatment, stresses Dr. Payton. Therapy will vary depending on the severity of your tear. Initially, your physical therapist will focus on gentle stretching and strengthening to prevent muscles from weakening and tightening up. As your pain improves, they’ll focus on strengthening your shoulder and rotator cuff muscles. “The goal is to gradually load the muscles until they’re able to exercise without pain, and with close to full range of motion,” explains Dr. Payton. The goal, of course, is to get you back to the activities you love. Research shows that about 75% of people who do physical therapy for rotator cuff tears for at least three months experience significant improvement.

Over the counter (OTC) medication. Pain relievers, such as ibuprofen (Advil, Motrin), naproxen (Aleve) and acetaminophen (Tylenol), can be helpful for shoulder pain related to rotator cuff tears. It’s important to make sure that you are safely able to take these medications, based on your medical history. Another option is the over the counter NSAID topical cream diclofenac (Voltaren).

Ice and heat. Ice is often more helpful in the first few days to reduce pain and swelling, says Dr. Payton. Apply it to the upper and outer portion of your shoulder muscle for 15 to 20 minutes every four to six hours. After about three days, you can use ice or heat. Test each out to see if one helps reduce symptoms like pain and stiffness more than the other.

Activity modifications. Movement is very important when healing from a rotator cuff tear to increase blood flow and healing nutrients to the area, says Dr. Payton. But initially, you may need to modify certain activities, such as overhead motions, that cause a lot of pain. You’ll be able to gradually work back to doing your activities normally as your rotator cuff muscles heal and become stronger. Here are some things to try if you’re having pain with specific movements:

• Try lifting objects close to your body to reduce pain.

• Consider lifting light weights, and lift only to below shoulder level. This includes reducing the weight of grocery bags or handheld purses or briefcases that you normally carry.

• Temporarily avoid or modify pushing exercises, such as pushups, bench presses, flies, and shoulder presses, if they cause a lot of pain.

• Do sidestroke or breaststroke if the forward crawl is irritating your shoulder when you swim.

• Adjust how hard you throw balls overhead, or even consider throwing balls underhand for a period of time.

Most people with rotator cuff tears see significant improvement in both pain and function within six to 12 weeks of starting physical therapy, says Dr. Payton. If you don’t, you should consult an orthopedic specialist. You may benefit from a steroid injection, which can help reduce pain and inflammation, or surgery.

A Word About Surgery

The American Academy of Orthopedic Surgeons recommends non-surgical treatments like strengthening exercises and physical therapy as first-line treatments for most tears. If symptoms haven’t improved after six to 12 months, you may be a candidate for surgery, especially if your tear is large (more than 3 cm).

Prueba estos ejercicios recomendados por los fisioterapeutas de Hinge Health. Aunque pueden ayudar a fortalecer y estirar los músculos del manguito de los rotadores para facilitar la curación de un desgarro, estos movimientos también son estupendos para la salud del hombro en general, dice el Dr. Payton. Intenta hacer esto varias veces a la semana para evitar lesiones, sobre todo si realizas muchos movimientos por encima de la cabeza por trabajo o diversión.

La información contenida en estos vídeos está destinada exclusivamente a fines educativos y no constituye consejo médico ni tratamiento para ninguna afección específica. Hinge Health no es tu proveedor de atención médica y no es responsable de ninguna lesión sufrida o exacerbada por tu uso o participación en estos ejercicios. Consulta a tu proveedor de atención médica sobre cualquier pregunta que puedas tener sobre tu afección o tratamiento médico.

Consejo de fisioterapeuta: Rompe

No siempre puedes evitar las lesiones de hombro o los desgarros del manguito rotador, pero si haces mucho trabajo repetitivo por encima de la cabeza, puedes hacer pausas cortas frecuentes como medida preventiva, aconseja el Dr. Payton. "Cada 20 minutos, relájate y deja descansar los brazos", dice. 

Cómo puede ayudarte Hinge Health

Si tienes dolor en las articulaciones o músculos que dificulta el movimiento, puedes obtener el alivio que has estado buscando con el programa de terapia de ejercicio virtual de Hinge Health.

Lo mejor es: no tienes que salir de casa porque nuestro programa es digital. Eso significa que puedes obtener fácilmente la atención que necesitas a través de nuestra aplicación, cuándo y dónde te funcione a ti. 

A través de nuestro programa, tendrás acceso a ejercicios terapéuticos y estiramientos para tu condición. Además, tendrás tu equipo personal de cuidado clínico para guiarte, apoyarte y adaptar nuestro programa a tus necesidades. 

Verifica si cumples con los requisitos de Hinge Health y confirma la cobertura gratuita a través de tu empleador o tu plan de beneficios, aquí.

Este artículo y su contenido se proporcionan únicamente con fines educativos e informativos y no constituyen asesoramiento médico o servicios profesionales específicos para ti o tu afección médica.

References 

1. Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N., Kikuchi, K., … Itoi, E. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of Orthopaedics, 10(1), 8–12. doi:10.1016/j.jor.2013.01.008

2. May, T., & Garmel, G. M. (2023, 26 de junio). Lesión del manguito rotador. PubMed; publicación StatPearls. http://www.ncbi.nlm.nih.gov/books/NBK557657/ 

3. Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., Brophy, R. H., Carey, J. L., Holloway, B. G., Jones, G. L., Ma, C. B., Marx, R. G., McCarty, E. C., Poddar, S. K., Smith, M. V., Spencer, E. E., Vidal, A. F., Wolf, B. R., & Wright, R. W. (2013). Eficacia de la terapia de ejercicio en el tratamiento de las roturas atraumáticas de espesor completo del manguito de los rotadores: un estudio de cohortes prospectivo multicéntrico. Journal of Shoulder and Elbow Surgery (Revista de cirugía de hombro y codo), 31(1), 123–132. doi:10.1016/j.jse.2012.04.001

4. Abate, M., Di Carlo, L., Salini, V., & Schiavone, C. (2017). Factores de riesgo asociados a las roturas bilaterales del manguito rotador. Ortopedia & Traumatología: cirugía & Investigación, 103(6), 841-845. doi:10.1016/j.otsr.2017.03.027

5. Kim, Y.-S., Kim, S.-E., Bae, S.-H., Lee, H.-J., Jee, W.-H., & Park, C. K. (2016). Progresión de los desgarros sintomáticos de espesor total y parcial del manguito rotador, medida mediante RM repetida. cirugía de Rodilla, Traumatología Deportiva, Artroscopia, 25(7), 2073-2080. doi:10.1007/s00167-016-4388-3

6. Sambandam, S. N. (2015). Roturas del manguito rotador: Un enfoque basado en la evidencia. Revista Mundial de Ortopedia, 6(11), 902. doi:10.5312/wjo.v6.i11.902

7. McGrath, T. (2023, 27 de octubre). Tratamiento de las roturas del manguito rotador. UpToDate. https:// www.uptodate.com/contents/management-of-rotator-cuff-tears 

8. Simons, S. M., Dixon, J. B., & Kruse, D. (2023, 11 de mayo). Presentación y diagnóstico de las roturas del manguito rotador. UpToDate. https:// www.uptodate.com/contents/presentation-and-diagnosis-of-rotator-cuff-tears