Proper Ways to Manage Rotator Cuff Tears

Rotator cuff tears are a common shoulder injury that can result in pain, weakness, and limited range of motion. While surgery may be necessary for some tears, conservative treatment options are often effective for managing symptoms and improving function. In recent years, there have been significant advances in our understanding of the best practices for conservative management of rotator cuff tears.

What is the Rotator Cuff?

The rotator cuff muscles consist of four key muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. Located deep within the shoulder, they work in harmony to facilitate a range of motions and stabilize the joint during movement. Acting as a dynamic support system, these muscles help to keep the head of the humerus securely within the shoulder socket, preventing dislocations and enabling smooth and controlled movements. From reaching overhead to throwing a ball, the rotator cuff muscles provide the necessary strength and coordination for everyday activities as well as athletic performance.

The following are the best practice guidelines for conservative management of rotator cuff tears

Physiotherapy

Physiotherapy (physical therapy) is often the first line of treatment for rotator cuff tears.

Here are some common physical therapy strategies that can be employed:

1. Pain and Inflammation Management: Your physiotherapist may use various modalities, such as ice or heat therapy, ultrasound, or electrical stimulation, to help reduce pain and inflammation in the affected area.
2. Range of Motion Exercises: Initially, gentle range of motion exercises are introduced to improve flexibility and maintain joint mobility. These exercises focus on gradually increasing the shoulder’s range of motion without causing further damage or discomfort.
3. Strengthening Exercises: As the healing progresses, specific strengthening exercises target the rotator cuff muscles and surrounding shoulder muscles. These exercises aim to rebuild strength and stability in the shoulder joint. Examples include resistance band exercises, external and internal rotation exercises, and scapular stabilization exercises. It is best to have your symptoms assessed to get a clear plan of what muscles to strengthen. You risk the chance of further injury if you start with exercises that are too provocative or are acting against your symptoms.
4. Manual Therapy Techniques: Hands-on techniques like massage, joint mobilizations, or soft tissue mobilizations to improve tissue flexibility, reduce scar tissue formation, and enhance overall joint function.
5. Posture and Body Mechanics Education: Proper posture and body mechanics are crucial in preventing further strain on the rotator cuff muscles. Phyiotherapists educate patients on maintaining correct alignment during daily activities, lifting techniques, and sports-specific movements to reduce stress on the shoulder joint.
6. Functional Training: Once the strength and range of motion have improved, physiotherapists incorporate exercises that simulate real-life activities or sports-specific movements. This helps patients regain functional abilities and return to their desired activities or sports safely.
7. Home Exercise Program: A customized home exercise program is often prescribed, allowing patients to continue their rehabilitation outside of therapy sessions. Consistency with these exercises is crucial for long-term recovery.

Beyond Therapy

Your doctor may also prescribe NSAIDS or possibly consider corticosteroid injections should your symptoms not improve.

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen and naproxen can help reduce pain and inflammation associated with rotator cuff tears. However, they should be used with caution and under the guidance of a healthcare provider to minimize potential side effects.

Corticosteroid injections: Corticosteroid injections are often used to reduce inflammation and pain associated with rotator cuff tears. However, they should be used judiciously and only as part of a comprehensive treatment plan, as they may have potential side effects and can weaken the tendons over time.

Activity Levels

Resting the affected shoulder and modifying activities that aggravate the symptoms can help reduce pain and promote healing of the rotator cuff. Patients should avoid activities that require repetitive overhead motion or heavy lifting, which can place additional stress on the shoulder joint.

It is important to note that the best practice guidelines for conservative management of rotator cuff tears will vary depending on the severity of the injury, the patient’s age and overall health, and other factors. Therefore, it is important to work with a healthcare provider to develop a personalized treatment plan.

Also see; Treating Plantar Fasciitis

References

1. Kuhn JE. Exercise in the Treatment of Rotator Cuff Impingement: A Systematic Review and a Synthesis of Best Evidence. Phys Sportsmed. 2016;44(1):75-84.
2. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978.
3. Weiss LJ, Wang D, Hendel M, Buzzerio P, Rodeo SA. Management of Rotator Cuff Injuries in the Elite Athlete. Curr Rev Musculoskelet Med. 2018 Mar;11(1):102-112. doi: 10.1007/s12178-018-9464-5. PMID: 29332181; PMCID: PMC5825345.
4. Kuhn JE. Orthopaedic Knowledge Update: Shoulder and Elbow 5. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014.