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Rotator Cuff Injury

Table of Contents

 Rotator cuff injury is a medical condition where the injury occurs in the Rotator cuff muscle or tendon. There are Four Rotator cuff muscles and their major functions are :

1. Supraspinatus    – Abduction

2. Infraspinatus      – External Rotation

3. Terse Minor       – External Rotation

4. Subscapularis      -Internal Rotation

Read more about Rotator cuff muscle 

A common classification used in rotator cuff injury was developed by Cofield (1982). Based on the level of tear in the Rotator cuff injury is as follows:

Small tear: less than 1cm

Medium tear:1-3 cm

Larger tear :3-5 cm

Massive tear: greater than 5 cm

What are the Causes of  Rotator cuff injury?

  • Trauma: Accidents, Road traffic accidents, Falls from ladders, child abuse, bullying, or domestic violence.

  • FOOSH- fall on the out-stretched hand

  • When any person tries to Lift heavy weights there are high chances of injury 

  • With age, there is gradual degeneration of muscle and tendons. So elderly population has a high risk of Rotator cuff injury.

  • Repetitive Overuse movement leads to micro damage in muscle and tendons which accumulates and leads to injuries.

What are the signs and symptoms of Rotator cuff injury?

  • Classic night pain(In full in-thickness Rotator cuff tear )
  • Weakness noted in muscles and lateral rotators pain(In full thickness Rotator cuff tear )
  • pain with overhead activities
  • Shoulder stiffness
  • Compensatory Pain
  • Loss of motion

How to treat Rotator cuff injury ?

Conservative management – such as rest, ice, and physiotherapy is the effective treatment protocol for rotator cuff injury.

Injection – Steroid Injection injected into the shoulder joint might help in pain relief which affects sleep and daily activities. They just provide temporary relief for a short period.

Surgical Treatment – There are various surgical methods used to treat rotator cuff injury such as Arthroscopic tendon repair , Open tendon repair , Tendon transfer , Shoulder replacement etc .

Physiotherapy Management 

Phase I: Protection and Pain Management (week 0-4 )

Rehabilitation Goals

  1. Protect the healing tissue
  2. Manage pain and inflammation
  3. Maintain  ROM

ROM

1. Passive ROM exercise for the shoulder within a pain-free range.

2. Active assisted ROM: Shoulder flexion, Shoulder flexion with cane, side lying elevation to 90 degrees.

Manual therapy

Gentle soft tissue mobilization and joint mobilization technique

Phase II: Restoration of Range of Motion(week 4-8)

Rehabilitation Goals

  • Gradually improve  ROM
  • Maintain Pain control
  • Enhance scapular stabilization

ROM

1. Passive ROM and  Active assisted ROM: seated shoulder elevation with cane supine flexion, wall climbs, salutes, supine punch.

2. Gentle stretching: Triceps, lats, sleeper stretch, hand behind head, side lying horizontal ADD.

Strengthening    

  1. Anterior deltoid – isometrics exercises then slowly progresses to isotonic
  2. Scapular stabilization- scap retraction, Inferior glide, Prone scapular retraction.

Balance and coordination exercise:

Manuel Therapy: Soft tissue mobilization, joint mobilization, myofascial release technique

Phase III: Progressives Strengthening (8-12 weeks)

Rehabilitation Goals

  • Maximum shoulder strength and stability
  • Enhance dynamic scapular control
  • Gradual return to functional activities

Strengthening

  1. Anterior deltoid – isometrics exercises then slowly progresses to isotonic
  2. Rotator cuff Strengthening: Progressive resistance exercise (rotator muscle z) using resistance bands or light dumbbells,
  3.  Scapular stabilization: Progressive resistance exercise (rotator muscle z) using resistance bands or light dumbbells,
  4. Core and Lower extremities

Functional  Training: Lifting, carrying objects, push-ups, resistance band forward punch, etc.

Manual therapy:  Soft tissue mobilization, joint mobilization, myofascial release technique.

Phase IV: Return to function (12+ weeks)

Rehabilitation Goals

  • Maximum shoulder flexion
  • Improve strength and endurance
  • Return to desired activities

Strengthening

1. Exercises: Wall push-up, External rotation at 90 degrees, internal rotation at 90 degrees,  PNF –D1 diagonal lifts, PNF –D2 diagonal lifts, Resistance band PNF pattern.

2. Activity –specific exercise.

Related Articles 

Rotator cuff muscle – physiobia

The rotator cuff muscle is a fibrous sheath from by 4 flattened tendons that blend with the capsule of the shoulder joint and strengthen it. 

Glenohumeral Joint: Bones, ligaments, movement

The glenohumeral joint also called as shoulder joint is a ball and socket type of synovial joint with three rotatory and three translatory degree of freedom. 

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