Helping Your Shoulder Pain: Rotator Cuff Rehab and Treatment

Introduction to Rotator Cuff Injuries

Rotator cuff tears and injuries are one of the most common sources of shoulder pain.  The rotator cuff is made up of four muscles that surround the shoulder and form a “cuff” of tendons.  Those four tendons are the supraspinatus, infraspinatus, subscapularis, and teres minor.  The rotator cuff muscles aid in moving the shoulder and provide stability and strength for movement, particularly overhead use.  Any of these tendons can be injured, but the supraspinatus is most common.

Rotator cuff injuries can occur from a variety of causes.  Sometimes a tear occurs from a traumatic shoulder injury, such as a fall on the shoulder, forceful lifting, or throwing.  Other times injuries can occur from aging or “wear and tear”.  In addition, injuries to the rotator cuff can include rotator cuff tendonitis, partial thickness tears, or full thickness tears.  Rotator cuff tears are most common in patients over the age of 40.  Symptoms of a rotator cuff injury can include:

• Pain
• Weakness
• Limited range of motion

Pain most commonly occurs when reaching overhead.  Rotator cuff tears can also commonly cause pain at night and lead to difficulty sleeping.

Evaluation for the severity of a rotator cuff injury can include an orthopedic examination, x-rays of the shoulder, and in certain cases, an MRI may be indicated.  Depending on the severity of an injury, there are several treatment options. 

Non-Surgical Treatment Options

Most shoulder pain caused by rotator cuff injuries can initially be treated with non-surgical treatment.  These treatment options include:

• Rest and activity modification
• Ice and heat
• Non-steroidal anti-inflammatory medications
• Local corticosteroid injection
• Physical therapy and directed exercises

Rotator Cuff Rehabilitation Process

Rotator cuff rehabilitation is focused on reducing pain and swelling, restoring joint mobility, rebuilding shoulder strength, adding functional training, and returning to sports or work and normal activities.  Rehabilitation for rotator cuff injuries can be successful in cases of rotator cuff tendonitis, even in cases of full thickness rotator cuff tears, and are critically important for post-surgical recovery.  The rehabilitation process is typically broken down into several stages:

• Stage 1: Pain and Swelling Reduction
  • This phase focuses on immediate post-injury or post-surgical recovery.  This stage includes the use of ice, gentle massage, and early mobilization.  Exercises in this stage include pendulum swings, passive range of motion (PROM) exercises, and gentle stretching.
• Stage 2: Restoring Joint Mobility and Range of Motion
  • As pain is controlled, there is additional focus on improving flexibility and joint mobility.This stage includes passive and beginning active range of motion, wall climbs, and shoulder pulley exercises.
• Stage 3: Rebuilding Shoulder Strength
  • During this stage, resistance training is introduced to strengthen the rotator cuff and surrounding muscles.  Exercises include resistance band work, emphasis on shoulder internal and external rotation strengthening, and scapular stabilization exercises.
• Stage 4: Functional Training and Coordination
  • As shoulder motion and early strength improve, there is emphasis on functional strengthening and coordination for daily activities.The addition of proprioceptive and stability exercises (understanding the position in space) are included at this stage, and involve cable pulls and medicine ball exercises.
• Stage 5: Return to Sports and Normal Activities
  • This stage focuses on integrating sports-specific activities or simulation of occupational movements.This can include rehab exercises for full function, including throwing and overhead movements and lifting

If a rehabilitation program fails, and someone has persistent shoulder pain or weakness with a full thickness tear, surgery can be indicated.

Surgical Treatment and Post-Surgery Rehab

Almost all rotator cuff tears can be fixed utilizing arthroscopic surgery.  This minimally invasive procedure involves a small camera and instruments to visualize the tear, and the tear is repaired back to the bone utilizing sutures.  Arthroscopic surgery is highly successful for repairing rotator cuff injuries.  In cases of a more extensive tear, there are times an open incision or more extensive surgery is required.  An extensive rehabilitation program, as detailed above, is required for a successful outcome following surgical repair.

Long-term Shoulder Health and Injury Prevention

There are several strategies to prevent shoulder injuries. First, appropriate warm-up before strenuous athletic or work activities is important. This includes both stretching as well as regular rotator cuff strengthening exercises.  Gentle stretching for cool-down following activity is also important.  If persistent pain occurs during activity, “fighting through it” can lead to further injury or chronic pain from overuse.  If you have pain that persists for several weeks, or suffered a traumatic injury, with significant pain, weakness, or instability, an orthopaedic evaluation is warranted.

If you are experiencing shoulder pain, undergoing appropriate evaluation for a treatment plan is essential.  There are other causes of shoulder pain, and getting a proper diagnosis is critical.  Most shoulder conditions, including rotator cuff injuries, can be treated with an appropriate non-surgical treatment plan.  If you want to relieve pain, restore function and regain mobility, see a Rothman specialist today!