Physical Therapy for Rotator Cuff
Reviving the Rotator Cuff: Rehab for Rotator Cuff Injuries
Over 2 million people a year in the United States will visit their doctor because of a rotator cuff tear, according to the American Academy of Orthopedic Surgeons. Injuries to the rotator cuff of the shoulder can affect your ability to perform daily tasks like washing your hair, picking up your kids and even sleeping comfortably. The rotator cuff consists of four muscles that play an important role in the function of the shoulder and require different treatment depending on the severity of the tear. In many cases, conservative treatment like physical therapy can be very helpful in managing the symptoms of a rotator cuff tear. If you have a rotator cuff tear or think you may have one, read on to learn more about this injury and how physical therapy can help.
GET TO KNOW THE ROTATOR CUFF
The rotator cuff is a group of four muscles located at the shoulder. The shoulder joint consists of the humerus bone of the upper arm where it meets the glenoid cavity created by the scapula or shoulder blade. The shoulder, or glenohumeral joint as it is anatomically known, is a ball-and-socket joint that allows for a high degree of movement of the arm. The four muscles of the rotator cuff are the supraspinatus, the infraspinatus, the teres minor and the subscapularis. Let’s take a brief look at each muscle and the role that it plays in the shoulder joint.
The subscapularis muscle is located at the top of the shoulder joint. Its muscle belly originates in a hollow area at the top of the scapula or shoulder blade called the supraspinous fossa. Its tendon connects to the upper part of the humerus bone near the shoulder. This muscle aids in lifting the arm up at the side, a movement called “abduction”
Next is the infraspinatus who’s muscle belly lies just below that of the supraspinatus. Its tendon wraps around the outside of the humerus and aids in rotating the arm outward, a movement called “external rotation”.
Just below that muscle, on the scapula, lies the teres minor. This muscle follows the path of the infraspinatus and aids in rotating the arm outward, a movement called “external rotation”.
Finally, the subscapularis muscle actually lies on the underside of the scapula closest to the ribcage. The tendon of this muscle travels through the axilla or underarm to attach near the front of the humerus and aids in rotating the arm inward, a movement called “internal rotation”
As you can see, the muscles of the rotator cuff are essential to many of the movements performed by the shoulder. Not only a mover of the arm, however, the rotator cuff also provides stability to the shoulder joint by helping to keep the head of the humerus centered in the glenoid cavity throughout movement. This is necessary to generate the range of motion and force normally available at the shoulder.
WHEN THE ROTATOR CUFF TEARS
Rotator cuff tears or strains are not uncommon but can present differently depending on the severity of the injury and the location. Any of the four muscles can be injured. Oftentimes rotator cuff tears are the result of progressive wear of the muscle and tendon over time such as with repetitive overhead lifting or work, but it can also result from a single incident such as a fall or accident. A tear can range from minor to severe and may involve the muscle, the tendon or the musculotendinous junction. The presence of pain, swelling and weakness can indicate the severity of the injury. With rotator cuff injuries it is common to experience pain in the shoulder area and pain or weakness when trying to raise the arm to the side, rotate it inward or outward.
Grade I strain (mild): very few muscle fibers are injured. Pain typically occurs the next day but no swelling or bruising is observed. Pain may be felt when the affected muscle is strongly contracted or stretched at its end range.
Grade II strain (moderate): many (but not all) fibers are injured resulting in stiffness, loss of flexibility and loss of strength. Pain is felt both during contraction of the muscle and during stretching. Swelling and bruising over the injured area is common.
Grade III strain (severe): all fibers of the muscle are completely torn or the muscle belly has detached from its tendon. Severe pain is often felt upon injury and heavy swelling and bruising will develop. Range of motion may be either significantly reduced due to pain or excessive because the muscle is no longer limiting it. This muscle will generally be unable to produce any force due to the severe disruption in the fibers.
In the case of a severe strain or tear, a surgical approach may be recommended to restore function to the muscle. Age, functional level and the presence of other surgical risk factors all play a role in the decision to repair a severely torn rotator cuff surgically. In many cases, conservative treatment like physical therapy is recommended to promote healing of injured tissues, reduce pain and inflammation and restore function to the shoulder.
WHAT DOES PHYSICAL THERAPY FOR A ROTATOR CUFF INJURY LOOK LIKE?
During the acute phase of healing which typically refers to the 5-7 days immediately post-injury, the goal of physical therapy will be to protect the site of injury. During this phase, the body will begin to repair the injured tissue but at this point those repairs are very delicate. Any stretching or strong contraction of the injured muscle could re-tear the healing tissue causing the healing process to regress or begin again.Splinting or bracing may be recommended to limit excessive movement or stretching of the muscle and help reduce pain. Application of ice or other modalities like ultrasound or electrical stimulation may be used to reduce pain and promote healing. Passive range of motion performed by your therapist may also be introduced during this time.
As the muscle tear begins to heal your PT may begin to apply very gentle stretching to help maintain tissue flexibility and later on more intensely to restore muscle length. You will begin to perform exercises to restore the motor control and coordination of the muscle initially and the strength and power of the muscle later on. Your physical therapist will help educate you on signs that your muscle is ready to progress to the next stage of rehab and signs that you have overstressed the tissues, such as increased swelling or prolonged pain, and advise you on how to care for it. In later stages of rehabilitation your treatment plan will focus on helping you return to the activities you need to do for life, sports and work.
If you had surgery to repair a severely torn muscle, your physical therapist will help to progress you through your post-surgical protocol with the same goals of managing pain, decreasing swelling, improving flexibility and restoring strength and coordination.
Whether you are an athlete wanting to get back out onto the field or an injured worker trying to get back to your job, working with a skilled physical therapist will help you heal more thoroughly. If you have injured your shoulder, call Evolve PT today to schedule an evaluation with one of our experienced physical therapists.
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