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The management of rotator cuff injuries should be immediate either when it is related to an injury or when it is related to chronic degeneration and the first symptoms appear. In this way, the patient is given the opportunity to restore the strength and range of motion of the joint, as without treatment, inflammation and rupture can lead to weakness and loss of function.
The type of treatment depends on a number of factors, such as the symptoms and whether they are related to the rotator cuff injury, activity level and age of the patient.
The presence of a rotator cuff rupture and the patient’s non-compliance with a treatment protocol may lead to further worsening of symptoms. Chronic shoulder pain that is exacerbated by movement is one reason for an orthopedic visit and early conservative treatment can prevent long-term surgical treatment.
The goal of any treatment is to alleviate pain and restore joint function. There are various treatment options for ruptures of the rotator cuff and the physician chooses the most appropriate one and adjusts it to the patient. As mentioned above, the orthopedist assesses the age, activity level, and general condition of the patient, along with the size and type of rotator cuff injury or rupture.
There is no indication that immediate surgical repair of the rotator cuff results in better post-rupture results, which reinforces the view that conservative treatment should first be tried before any thought of rehabilitation intervention.
In about 50% of patients, conservative (non-surgical) treatment relieves pain and improves shoulder functionality, but does not affect the strength that is usually improved by surgery.
Conservative treatment of degeneration or rupture of the rotator cuff:
Pain Relief:
- Avoid painful movements and activities
- Analgesic drugs
- Non-steroidal anti-inflammatory drugs
- Physical therapy
- Subacromial injection of corticosteroids (cortisone)
- Nerve occlusion (block) of the suprascapular nerve with bupivacaine
Restoration of movement:
- Program of stretching of the shoulder joint and shoulder muscles
- Kinesiology focusing on the glenohumeral (shoulder joint), thoraco-scapular, acromio-clavicular and sterno-clavicular joints, as well as the muscles
- that stabilize the scapula on the chest wall
- Physical therapy for the cervical and thoracic spine, due to the close relationship with the shoulder and the restoration of shoulder strength by strengthening the
- the rotator cuff muscles, the shoulder-stabilizing muscles and the latissimus dorsi and major thoracic muscles
Proprioception:
- In a young person who has early degenerative rotator cuff injuries due to shoulder instability, physiotherapy should be supplemented by proprioception exercises.
Rehabilitation for athletes:
- In an athlete after the first period of physical therapy, a specific program with specific exercises depending on the sport should be commenced before the resumption of normal sports activities.
- With the aging of the working population, this aspect of rehabilitation along with the gradual return to sporting activities should not be overlooked.
- A recent study has shown that in patients with massive, irreversible rotational rupture, the results are better in those with single rupture of the posterior edge of the rotator cuff than in those with rupture of the anterior edge or rupture of three or more tendon tendons. In this study, which included 45 patients, limb elevation above 160 ° was achieved in 24 patients, with a higher failure rate in patients with subscapularis ruptures or patients with rupture of three or more tendons.
Physiotherapists – in collaboration with the treating physician – should be careful with the various treatment options and their application in the treatment of rotator cuff ruptures. A number of excellent articles have been published on the various therapeutic approaches for the painful shoulder. Based on these articles, there is insufficient evidence to prove the efficacy of most treatment options for treating shoulder pathologies. In particular, based on these studies, it appears that ultrasound therapy, transdermal electrical nerve stimulation (TENS), magnetotherapy, as well as different methods of thermotherapy are not effective in the treatment of various shoulder diseases, and in particular, rotator cuff ruptures.
However, the treatment with electromagnetic fields and low-power laser are associated with short-term efficacy compared to placebo.
In conclusion, non-surgical treatment may provide relief from the rupture of the rotary cuff in only a portion of patients. Overall, about 50% of patients will benefit from the conservative treatment program and the end result will depend on parameters such as the size of the rupture, the age of the patient and the duration of the injury, among others. Exercises, in the context of physiotherapy, create new blood vessels in the injured tendons while strengthening neighboring muscles to compensate for the deficiency of the degenerated part of the rotator cuff.
Non-surgical treatment is often the first-line therapy, whether we choose it as a definitive treatment or aim for surgical repair of the rupture. In the latter case, conservative treatment allows for the recession of the inflammation that accompanies a rotator cuff rupture and the maintenance of shoulder mobility until surgery.
