Rotator Cuff Injuries
Rotator Cuff Injuries are quite a common occurrence in both the sporting and the older populations. These injuries can range from a minor local inflammatory reaction to a partial to full thickness tear (single rotator cuff tendon/muscle involvement to multiple tendon/muscle involvement). Physiotherapists are able to treat rotator cuff injuries throughout the healing phases.
If the rotator cuff tendons are swollen due to impingement, physiotherapy treatment can assist from the acute phase through to end stage rehabilitation or return to sport. Early treatment involves decreasing local inflammation, workplace/lifestyle temporary modifications, manual therapy and improving biomechanics to decrease impingement potential. Treatment will include posterior gleno-humeral joint capsular stretching, muscle stretching and strengthening, thoracic and cervical spine mobilisations, and correction of sporting technique if appropriate. Taping and dry needling may also be trialled.
Rotator Cuff Tendinopathy
Rotator cuff tendinopathy is a progressive condition where pain gradually comes on within the shoulder from overhead repetitive movements of the shoulder without sufficient rest and tendon adaptation. Pain generally begins deep in the shoulder and may radiate into the deltoid muscle and even the shoulder blade. Rotator cuff tendinopathy commonly presents as tendinitis (inflammation of the tendon). If changes in workload and mechanics are not addressed, this condition can progress leading to further degeneration and even a partial to full thickness tendon tear.
The evidence suggests that conservative management is to be trailed for atleast 6 months before considering any surgical treatment options.
Physiotherapy conservative management may help with the 5 stages of recovery. These include: reducing pain by managing workload, recovering flexibility, recovering strength, recovering coordination and recovering function or return to sport.
A tear is defined as a muscle that has been torn less than 50%.
If there has been a minor tear of the rotator cuff, conservative management, similar to that for subacromial impingement, will generally lead to excellent results. In fact, the evidence suggests that conservative management is the initial recommendation for treating symptomatic rotator cuff tears. There is little evidence that suggests surgery is more effective than that of conservative management for an initial treatment. For larger tears that may require surgical repair, physiotherapy treatment post surgery is essential to strengthen the weakened tissues and to correct any biomechanical dysfunctions that may have originally contributed to the tear, to not only prevent recurrence of the injury, but also to ensure that the best possible post-surgical outcome is achieved. Returning to full shoulder range and strength following surgery will allow the patient to be fully functional even to the point of return to high level sporting endeavours. Physiotherapy treatment post surgery can start immediately to decrease the potential loss of the muscle tone of the scapular stabilisers (particularly lower trapezius and serratus anterior) and to prevent cervical/thoracic complications due to wearing the shoulder sling and brace. Most orthopaedic surgeons have their own post operative treatment protocols, and these treatment protocols are gradually becoming more accelerated.
Arthroscopic surgery can be used effectively for a variety of surgical procedures, including cleaning out arthritic shoulder joints, repairing tears that are suitable for surgery, removing spurs on the lateral process of the acromion to increase the subacromial space, removal of the bursa, and even to repair the labrum. The evidence suggests that there are no significant differences between cuff repair surgery and conservative management at a 12 month follow up for a small supraspinatus traumatic tear. Failure of conservative management for minor shoulder conditions, or patient presentation with major pathology, is usually followed by referral to an orthopaedic surgeon with an interest in upper limb conditions.