Rotator Cuff Management

• Advice & education:

  • help pts understand whats happening and the evolution of the pathology - tissues dont recover quickly, can take months rather than days/weeks
  • if the shoulder is irritable, consider significant rest and reduced the aggravating activities
• Symptom control:

  • are they taking anti-inflammatories, painkillers etc
  • are they a good candidate for a local injection
  • consider offloading the shoulder, so taping or bracing in the early stages
• Build capacity:

  • when the pain is managed, you want to start stimulating the tendon, whilst respecting pts symptoms and pain levels, to start to build strength particularly with the muscles surrounding the tendon - strength is key with rehab of rotator cuff
• Return to function:

  • highly individualised
  • match pts goals to your clinical goals
  • be realistic
  • continue to monitor and reassess your treatments
  • if treatments arent working, try a different stratergy or consider a referral
• Treatment components:

  • rest - important in the early stages
  • pain modifying modalities
  • medication
  • taping
  • exercise
  • early isometrics to maintain capacity of muscles until pts are ready for dynamic exercises
  • consider exercises on nondominant side - evidence of learning effect, particularly with motor control and proprioception, across midline of body
  • progress to eccentric when able
  • injection therapy - last resort, can be beneficial when coupled with physiotherapy during certain stages of disease process
  • surgery - last resort, doesnt make large difference with long term outcomes
• Treatment components - variables:

  • what is the best exercise for rotator cuff related shoulder pain
  • should we be focusing on the rotator cuff or the scapula
  • how much pain is okay to tolerate during and after treatment
• Treatment components - modifiable features:

  • volume (reps, sets, weight)
  • frequency - how often
  • range of motion - in accordance with pain/stiffness
  • mode - how the exercise is performed i.e. speed, type of contraction
  • consider the surrounding joints as well as non affected side