Header

Rehabilitation for Rotator Cuff Injury

The rotator cuff is the thick band of muscles and associated tendons that covers the top of the upper arm and holds it in place, providing support and stability to the shoulder joint. The rotator cuff also allows for a full range of motion while keeping the ball of the arm bone in the shoulder socket. These tendons can become partially or completely torn as a result of a rotator cuff tear or injury. A rotator cuff tear can occur as a result of overuse of the muscles over a long period of time with eventual degeneration of the tendon and then tearing. This condition is more common in individuals over the age of 40 as well as in athletes or those who practice repetitive lifting or arm movement in their occupation. A rotator cuff injury may also occur as a result of a traumatic injury such as a fall, or shoulder dislocation.

Treatment may include conservative treatments such as rest, ice, physical therapy, steroid injection, and activity modification, while severe cases may require surgery for repair. The goal of any treatment is to reduce pain, improve function, and restore strength.

Nonsurgical Rehabilitation for Rotator Cuff Injury

In some cases, rotator cuff tears can be treated through nonsurgical methods that focus on relieving pain and restoring function to the shoulder. These may include rest, use of a sling, anti-inflammatory medication, steroid injections and physical therapy. Physical therapy exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade. Treatment may include:

  • Muscle strengthening exercises
  • Gradual weight-bearing activities
  • Range of motion exercises

The physical therapist may also make suggestions and create exercises for improving posture and shoulder alignment.

Rehabilitation After Rotator Cuff Surgery

In most cases, surgery will be recommended for tears that cause severe pain or that do not respond to more conservative treatments. The type of surgery performed depends on the size and location of the tear, but often involves trimming torn edges or suturing the tendon back together. Physical therapy often begins shortly after surgery to help restore strength and movement and allow patients to gradually resume their regular activities. Initial physical therapy treatments may include ice, electrical stimulation, and massage, to help control pain and swelling. As the healing begins, muscle-strengthening exercises and range of motion exercises may be used to increase movement and mobility.

Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results. The size of the tear and quality of the tissue play a large role in the recovery process. Similarly, smoking has been found to have a detrimental effect on the outcome following rotator cuff surgery.

If you are a smoker, resources are available to help you quit:
https://smokefree.gov

More Information

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.