By Jen Brown, DPT
You are helping your mom move furniture so she can clean the floors. One more piece of furniture needs to be moved before you can sit down to enjoy a homemade lunch. You bend down, lift, and feel a sharp pain in your shoulder. Could you have injured your Rotary Cuff?
You have spent the whole weekend repainting your house. Sunday night comes and your shoulder is throbbing in pain. Maybe it is your Rotator Cup?
We have heard it all; anything from Roter Cuff to Rotator Cup and everything in between.
It is actually your Rotator Cuff and is a fairly common injury seen in our clinic. The rotator cuff is a complex of four tendons that extend off muscles in the shoulder. Tears of these tendons are called Rotator Cuff tears. The four muscles are the subscapularis, supraspinatus, infraspinatus, and teres minor.
– Subscapularis works to internally rotate the arm. It is the motion that allows you to reach behind your back to tuck in your shirt. It is located deep inside on the front of the shoulder blade.
– Supraspinatus works to help raise the arm out to the side. It is located on the top of the shoulder blade and is the most common tendon affected.
– Infraspinatus and Teres Minor work together to externally rotate the shoulder. It is the motion that allows you to reach behind your head. They are located on the bottom of the shoulder blade.
Together the muscles of the rotator cuff work to stabilize and compress the humeral head. The shoulder is a ball and socket joint. The shoulder blade provides the socket and the humeral head is the ball. The rotator cuff’s primary purpose is to hold the humeral head in place when you move your arm.
Signs of a rotator cuff injury include pain, decreased mobility of the shoulder, and weakness. These are often secondary to inflammation deep in the joint from the injury.
⦁ PAIN – Rotator cuff injuries often can cause pain in the front, back and side of the shoulder. The pain is usually described as a dull ache at rest and sharper with overhead activity. It can also be severe at night.
⦁ DECREASED ROM (Range of Motion) – Inflammation in the joint can lead to pinching of the tendon making it hard to move the arm.
⦁ WEAKNESS – If there is detachment of the muscle from the bone during the rotator cuff injury, the shoulder will be weak, especially with overhead activity.
Causes of rotator cuff injuries vary from falls, to repeated overhead activity, to chronic wear and tear or degenerative changes. As we age our tendons lose blood supply and quality and are therefore more prone to tear.
PT Can Help!
Whether you have had surgery for a rotator cuff tear or have experienced a strain of your rotator cuff Physical Therapy can help. Improving motion and strength in the shoulder can significantly help improve symptoms.
Other treatment options include anti-inflammatory medication, steroid injections, ice, and possible surgery. Surgery is typically recommended if conservation measures fail or if there was a traumatic or acute tear of the tendon.
Typical Rehab for Rotator Cuff Repairs
Patients typically begin physical therapy at 2 weeks post-operative. You are usually in a sling for 6 weeks and are allowed to begin to move the arm on your own. Physical therapy lasts 12-16 weeks.
⦁ Phase 1: 0-6 weeks post-op – passive motion only; meaning the therapist moves the arm, the patient does not.
⦁ Phase 2: 6-12 weeks post-op – active motion phase in which the patient is moving their own arm through exercise.
⦁ Phase 3: 12-16 weeks post-op – focuses on strengthening of the rotator cuff. Despite being discharged from physical therapy at 3-5 months following surgery, final complete healing is not completed until near 1 year post-operative.
PT Is Important!
Physical therapy is vital following a rotator cuff repair of any degree. Even if you find that your pain is minimal and you feel your motion is good, physical therapy is still important. Passive range of motion (PROM) of the shoulder, performed by the physical therapist is essential to prevent the patient from developing stiffness or adhesive capsulitis (AKA Frozen Shoulder) of the shoulder. When there is a lack of movement in a joint, scar tissue and other adhesions can build up and block movement.
Attending physical therapy for the first 6 weeks allows for someone in the medical profession to monitor the incision site, supervise the correct use of the sling, as well as educate the patient on exercises to perform at home. In addition, regular physical therapy appointments also results in immediate feedback, continued modification to home exercises, and motivation which are all vital for optimal recovery.