Rotator Cuff Injury

Rotator cuff tear is the most common causes of shoulder pain and disability. The frequency of rotator cuff tears. Increases with age , with full thickness tear uncommon in patients younger than 40 years. The rotator cuff complex refers to the tendons of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor.

 Causes of rotator cuff tear

·  Acute injury

    A sudden injury, such as a fall or lifting something too heavy, can cause a tear.

·  Chronic wear and tear

   Repeated overhead motions, like in sports (tennis, baseball) or certain jobs (painting, construction), can gradually cause damage to the rotator cuff tendons.

·  Age

 Tendons weaken over time, and older adults are more likely to experience rotator cuff tears due to degeneration.

·  Trauma

Direct trauma, such as a car accident or falling onto an outstretched arm, can also lead to tears.

Symptoms

·  Pain: Often felt in the shoulder or upper arm, particularly when lifting the arm or lying on the affected side.

·  Weakness: A noticeable reduction in shoulder strength and range of motion.

·  Limited range of motion: Difficulty reaching overhead or behind the back.

·  Pain at night: Especially while sleeping on the injured shoulder.

Physiotherapeutic treatment

Acute Phase (Pain Management and Healing).

• Avoid movements that aggravate the shoulder (e.g., lifting overhead). Using a sling might be recommended in the early stages to immobilize the shoulder.
• Applying ice packs can reduce swelling and pain, while heat can help relax tight muscles once inflammation has subsided.
• Leaning forward while letting the arm hang down, and then gently swinging the arm in circles or back-and-forth.
•  A therapist may assist in moving the arm to avoid straining the rotator cuff tendons.
• The therapist may use techniques like soft tissue mobilization or joint mobilizations to reduce stiffness and improve movement in the shoulder.

 Strengthening Phase (Restoring Function)

• These exercises involve contracting the muscles without moving the joint. For example, the patient might press the arm against a wall or resistance band without moving the shoulder. This helps maintain muscle strength while minimizing strain on the tendon.
• Using a resistance band, the patient holds their arm at a 90-degree angle and rotates outward.
• Holding the arm in a similar position, the patient rotates the arm inward against the resistance.
• Squeezing the shoulder blades together to strengthen the muscles around the shoulder blade (scapula) and improve shoulder stability.

• Strengthening muscles that stabilize the shoulder blade (scapular muscles) is important for shoulder function. Exercises like wall slides and scapular push-ups can help with this.
• Gradually, with guidance from the therapist, the patient will progress to exercises that require lifting or pressing the arm, but with light weights and controlled movements.

 Advanced Strengthening and Functional Phase

• Gradually increase the resistance in exercises such as shoulder presses, lateral raises, and rows, while maintaining good form to avoid re-injury.
• Continued emphasis on strengthening the muscles involved in stabilizing the shoulder joint and improving the mechanics of the shoulder, including exercises like:
• Lying face down, the patient lifts their arm with a light weight, rotating outward.
• Performing controlled movements that mimic the actions needed during sports or daily activities.

• Performing tasks that mimic everyday motions, such as reaching overhead or behind the back, carrying objects, or throwing a ball.
• For athletes, plyometric exercises (such as throwing or catching a medicine ball) may be included to improve explosive strength and power.