Rotator cuff injuries can be repaired naturally with rest, or surgically. Surgery includes open surgery, small incision surgery, and arthroscopic surgery. However, the core goals are rotator cuff healing, functional recovery and pain free. About 50% of people can reduce pain and regain function with non-surgical treatment. Doctors mostly recommend surgery for people who have suffered from chronic pain, followed by patients with symptoms of weakness. Weakness symptoms do not improve significantly without surgical treatment.
Conditions exist in which non-surgical treatment may result in adverse outcomes.
1. long duration of symptoms (6-12 months).
2. large tears (greater than 3 cm).
The advantages of non-surgical treatment are.
1. avoiding the risk of post-surgical adhesions.
2. avoiding the risk of infection.
3. avoidance of the risk of joint stiffness.
4. anesthetic complications.
The disadvantages are.
1, strength cannot be improved.
2.The extent of the tear will continue to increase.
3.The patient needs to constantly reduce the intensity of the movement and adjust the movement.
Rehabilitation principles.
I. It can be divided into two main categories: preoperative/conservative rehabilitation and postoperative rehabilitation.
2. The goals of preoperative rehabilitation are to improve joint mobility, prevent adhesive capsulitis, strengthen the muscles around the shoulder joint for possible postoperative rehabilitation; and to minimize the stress response.
3. Once the inflammatory response is reduced, the core of rehabilitation is to improve joint mobility and muscle strength. (The inflammatory response is usually 72 hours, and oral anti-inflammatory and pain medication and ice should be applied)
1. active joint movement (shoulder shrugging, chest expansion, but not active abduction)
2. joint capsule contraction (forceful contraction of the shoulder joint)
3.Joint activity/myofascial relaxation (massage the muscles in the front and back of the shoulder joint after exercising them to relax them)
4. progressive muscle strength training (flexion of the elbow joint to practice biceps, extension of the elbow joint to practice triceps, chest expansion to practice pectoralis major and latissimus dorsi, shrugging to practice trapezius).
5. All muscle strength training should be painless.
4. After rotator cuff repair surgery, it must be ensured that there is no active joint activity for four weeks, and the shoulder joint must be fixed with a brace.
1. Rehabilitation must start from the first week after surgery.
2. rehabilitation must help with ROM (passive activities), especially flexion and external rotation.
3. active activities (AAROM) start from the first to the fourth week, depending on the length of the stress period.
4. once the limitation of active activity is lifted, muscle static training (muscle contraction with joint inactivity) should be started immediately.
5. Depending on the length of the stress period, scapular activities can be started early, with the following benefits
1.Improve the synchronization and rhythm of scapular and humeral movements.
2.Reducing the tension of the upper trapezius muscle to utilize for muscle balance. (Scapular exercises are to control the upper-outer-inferior circular rotation of the scapula)
Rotator cuff injuries are generally speaking immobilized for 4-6 weeks and no active movement can be performed. The physiotherapist must take care to prevent active movement and elevation of the forearm to minimize the possibility of retear. The patient must be informed of the possibility of re-tear.
1. It is for the above reasons that adhesive capsulitis is very likely and early PROM (passive activity) is encouraged.
2. Early passive activities are mainly flexion elevation and external rotation, while posterior extension, internal rotation and placing the hand behind the back create a lot of tension in the rotator cuff and should be avoided in the early stages.
3. Passive joint activities should position the humeral head posteriorly, when it is in the center of the shoulder glenoid fossa, a position that improves the dynamic characteristics of the shoulder joint. Improves mobility and reduces stress response.
4.Massage of the muscles in front of the shoulder joint and other soft tissues can reduce the tension in front of the shoulder joint.
5.Massage of the upper trapezius muscle can reduce pain, thus protecting the joint to form good joint dynamics characteristics.