Recovering from rotator cuff injuries: How physical therapy accelerates recovery from rotator cuff injuries
What is rotator cuff and rotator cuff injury?
The rotator cuff is a group of muscles which provides stability to shoulder joint. The rotator cuff consists of four muscles: Subscapularis muscle, Teres Minor muscle, Supraspinatus muscle and Infraspinatus muscle. Rotator cuff tear is classified when at least two tendons are completely torn or at least one of the two tendons are retracted beyond the top of the humeral head.
These rotator cuff tears can be further divided into 5 categories:
- Type A: supraspinatus & superior subscapularis tears
- Type B: supraspinatus and entire subscapularis tears
- Type C: supraspinatus, superior subscapularis & infraspinatus tears
- Type D: supraspinatus & infraspinatus tears
- Type E: supraspinatus, infraspinatus & teres minor tear
Most commonly tears are described as partial- or full-thickness. The classification system is:
- Small tear: less than 1 cm
- Medium tear: 1–3 cm
- Large tear: 3–5 cm
- Massive tear: greater than 5 cm.
Causes:
- Repetitive micro trauma to the involved side.
- Severe traumatic injury like falling on outstretched hand, shoulder dislocation, or injury caused by unexpected force in pushing or pulling.
- In old age because of degenerative changes.
Signs and symptoms:
- Pain at night, especially lying down on involved side.
- Pain with all overhead activities.
- Weakness of involved muscle.
- Stiffness in shoulder joint.
Examination by physical therapist for injury of different muscles:
Special tests are performed by therapist which reproduces the symptoms are considered as positive. Different tests for different muscles are performed passively on the patients.
Tests for subscapularis:
- Lift-off test and Passive Lift Off Test
- Belly Press
- Belly-off sign
- Bear Hug Test
Tests for subscapularis:
- External rotation lag sign: 0° and 90°
- Jobe’s test
- Drop arm test
- Neer test
Test for Teres minor:
- Hornblower’s Sign
Rehabilitation:
Acute phase: pain control management by modalities like therapeutic heat, cryotherapy, IFT, these modalities help in reduction of inflammation also. To prevent atrophy and contractures passive ROM is started. Periscapular muscle strengthening is used to improve scapulohumeral rhythm and manual therapy and scapular mobilisations are used along with strengthening to maintain and improve motion and thoracic kyphosis. Then progressed to active assisted and active ROM, isometrics and closed kinetic exercises to increase motor control. Targeted stretching of posterior capsule like sleepers stretches are done. Kinesiotaping to improve shoulder kinematics and enhance neuromuscular control.
Recovery phase: painless full ROM is achieved in this phase. Scapular stabilization exercises like low rows, prone scapular retraction/ squeeze, wall pushups, scapula pushups. Strengthening of deltoids, internal and external rotators by isometrics in supine to standing positions then progressed to resistance. Then progressed to eccentric exercises to strengthen all the muscles.
Functional Phase: activities of daily living or sports specific movements are incorporated to make patient more active in their day to day life. Closed kinetic chain exercises and resistive proprioceptive neuromuscular facilitation exercises to enhance joint proprioception. Eccentric exercises for strengthening are incorporated and sport specific activities like serving, throwing, with proper mechanics are started.
References:
1. Rodriguez-Santiago, B., Castillo, B., Baerga-Varela, L., & Micheo, W. F. (2019). Rehabilitation management of rotator cuff injuries in the master athlete. Current sports medicine reports, 18(9), 330-337.
2. Sciascia, A., & Karolich, D. (2013). A comprehensive approach to non-operative rotator cuff rehabilitation. Current Physical Medicine and Rehabilitation Reports, 1, 29-37
3. Jobanputtra, Y., Samal, S., Bawiskar, D., Chitale, N., Phansopkar, P., & Arora, S. (2021). Physiotherapy rehabilitation of rotator cuff injury. Journal of Medical Pharmaceutical and Allied Sciences, 10(6), 4057-59.
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