RC Tendinopathy Management

• Management of RC tendinopathy - summary of objectives:

  • ensure good strength/balance in rotator cuff activation
  • make it relevant to movement rather than an individual muscle - particularly external rotation, internal rotation and abduction
  • role of rotator cuff muscles is to maintain congruency and stability of humeral head, so collaborative action between all these muscles is important
  • correct movement faults (function is the goal)
  • reduce risk factors e.g. modify activities, postures
  • ensure good strength/balance in scapulothoracic movement
  • help pts stay focused and motivated
• • Management of irritable RC tendinopathy - early stages:
  • aim is to protect the tendon, control tenocyte activity +/- manage inflammation of bursa - tenocytes work very hard to protect the tendon, so give them space to do the work
  • ice, NSAIDs, taping, other medication to offload tissues
  • corticosteroids vs analgesia
  • analgesia has less secondary effects, so may be a better approach for the shoulder
  • reducing load will reduce aggravating activity
  • isometric muscle activity or tolerable isotonic +/- supported
  • build to provocative positions, slight discomfort is ok
  • identify movement faults
• • Management of non-irritable RC tendinopathy:
  • can progress from isometric exercises to isotonic - 3 x week
  • low ROM to high ROM progression
  • short lever to long lever
  • progressive resistance and speed of movement
  • focus on external rotation and abduction load
  • supported/unsupported/prone/side lying
  • add function requiring neuromuscular control
  • catching, throwing, progress to weight-bearing positions to stimulate tendon and bone tissues
  • monitor pain 3/10 and 24 hour response
• • Management of chronic RC tendinopathy & partial tears (degenerative & usually non-irritable) pt1:
  • aim: promote repair of unhealthy tendon or improve quality of remaining tendon and muscle - as tendons wont recover well due to changes of the quality of tendon tissues, theres decreased cell count, decreased vascularisation, decreased potential of tissue recovery, but surrounding tendons and muscles can still be rehabilitated and can be helped to maintain their strength and function
  • in lays terms - teaching the tissues to work harder and smarter to compensate for the damaged tissues
• • Management of chronic RC tendinopathy & partial tears pt2:

  1. exercise is the best approach - mechanotherapy for 6 weeks
  2. adjuncts/other therapies
  3. corticosteroid injections - pain relief, chronic inflammation
  4. extracorporeal shockwave therapy - acoustic pulses for pain management and tissue healing - conflicting evidence
  5. ice, heat, contrast baths to modulate pain - before or after exercise
  6. regenerative injection therapy - not well evidenced in efficacy
  7. surgery as last resort - evidence that consistent exercise for 12 weeks or more is equal to the outcomes of surgery in the long term