ROTATOR CUFF REHABILITATION
Rotator cuff tears are a common contributing factor of shoulder pain and occupational disability.
Tears of the rotator cuff are becoming increasingly prevalent in today’s musculoskeletal population. The
rotator cuff is a group of muscles and their tendons that act to stabilize the shoulder. The rotator cuff
muscles are important in shoulder movements and in maintaining stability. Accurate recognition and
successful treatment of patients with rotator cuff tears require thorough comprehension of the normal
and pathologic anatomy of the rotator cuff (Smith, Smith, 2010).
Rotator cuff tears are surprisingly common and afflict a wide range of people. Risk factors for
rotator cuff tears are age, smoking, and high cholesterol. Rotator cuff surgery most often involves reattaching the tendon to the head of the humorus (the upper arm bone). With a partial tear it may only
need a trimming, or smoothing procedure called a debridement. A complete tear requires the stitching
of both sides of the tendon. “Rotator cuff injuries are common problems and a frequent reason for
patients to present to primary care physicians. These injuries are seen more frequently with the aging
population. A thorough examination can lead to the diagnosis of rotator cuff pathology. Radiographic
imaging may offer some insight into the underlying pathology, and magnetic resonance imaging
provides for excellent visualization of the rotator cuff. Many rotator cuff tears, especially partial tears,
will symptomatically improve with conservative management. Surgical treatment may offer improved
pain and function in those patients for whom nonoperative care is insufficient ( Lansdown, Feeley,
2012)”.
The number one goal when dealing with rotator cuff tears is to get the tendon to heal. There are
few options for repairing rotator cuff tears. When a tendon tears, it becomes scarred in this new
position. It may not be possible to repair the tendon automatically. In these scenarios, the use of rotator
cuff graft may be used. An anti-inflammatory may be used as well to allow the shoulder to move with
reduced pain. Usually if a tendon is torn over many years, the muscle may atrophy. In this case, surgery
is pointless and will not improve function. “Surgical procedures that may be used to treat rotator cuff
disease include subacromial bursectomy, debridement of partial tears, subacroial decompression, and
removal of calcific deposits. Some procedures can be performed arthroscopically, which may result in
less morbidity and shorter recovery time enabling earlier return to work and/or sport. Open surgical
repair may be superior to arthroscopic debridement for overall improvement at five and nine year
follow up ( Coghlan, Buchbinder, Green, Johnston, Bell 2008). Alternatives to surgery include activity
modification, nonsteroidal anti-inflammatory medications, cortisone injections, and a physical therapy
program designed to maintain or improve shoulder range of motion and strengthen the deltoid,
scapular rotators, biceps, and intact rotator cuff muscles (Gartsman, 2009).
Rotator cuff injuries are in fact very common injuries. Unless properly treated, rotator cuff
injuries may last months or even years. Anyone can experience this type of injury and it may reduce your
ability to perform many common tasks. It is very difficult to keep from re-straining an injured shoulder.
Even when the pain is gone you still are not fully healed. That is when you start using your shoulder
normally even though it is not fully healed. What happens is that you end up continually reinjuring your
shoulder through daily activities. Re-injury should be avoided at all costs. Not only do you feel the pain,
but it also delays the healing process. With every re-injury, scar tissue builds up that is very difficult to
get rid of. Because of this scar tissue range of motion starts to become limited. This could lead to chronic
pain and arthritis. Taking the right steps in the healing process is very important not only for reduced
pain but for the probability that re-injury will not occur.