The diagnosis of a rotator cuff tear is not the end all with respect to a trip to a surgical suite. In fact, the majority of 65 year olds have identifiable rotator cuff pathology though most are functioning quite well and present with at most mild symptoms. Care for rotator cuff injury has many steps for most involved with the goal of exhausting multiple conservative care options before undergoing surgical intervention; which ultimately may not be a rotator cuff repair.
Injuring the rotator cuff is a life-long process with most people experiencing events of macro trauma (a fall onto the shoulder) and microtrauma (racket or throwing sports, house painter). Symptoms usually begin when people are in their 40’s and 50’s with onset again due to either micro or macro trauma. Rest, ice and non-steroidal anti-inflammatories are the first course of care.
When Symptoms Persist
If symptoms persist for more than a few days or if they are initially severe in nature, a doctor visit is advised. This second course of care may include stronger anti-inflammatory medication and an x-ray. If the magnitude of weakness is significant, an MRI may be scheduled. If the progression of pain symptoms has been slower with diffuse weakness, the medical provider may initiate physical therapy care prior to scheduling and MRI with the hope that correcting mechanical dysfunction about the joint will stabilize symptoms and allow for a return of functional strength.
If there are acute symptoms, ie following and event of macro trauma, the first goal of physical therapy is to stabilize symptoms and initiate mobility and functional strengthening to surrounding structure and ultimately the rotator cuff as symptoms stabilize.
For most people, the “rotator cuff experience” begins with pain and weakness following an event of microtrauma. This group is an ideal candidate for physical therapy care with the goal of correcting the mechanical faults that serve as the origin for the pain symptoms. This is the third course of care. This process can take multiple months to stabilize acute symptoms and restore mechanical function to alleviate compression on the rotator cuff and surrounding bony/joint and soft tissue structure.
One will not be under formal physical therapy for this complete time period, opting to work with their home exercise program once acute symptoms have stabilized and they are well on their way to recovery with the appreciation that their home exercise and mobility program will resolve the balance of symptoms.
As long as there are notable improvements in function and pain, this phase of the treatment program continues from 3 to 6 months with a goal of returning the patient to pre-injury levels of function. Once this has been attained, the patient continues periodically with this program to further enhance function and prevent future injury. Modification of daily activities and recreational interests is a crucial component as well and should be a discussion that is had with the physical therapy provider. As long as functional rotator cuff strength is maintained and pain symptoms are stable, the conservative process can continue.
If symptoms do not stabilize and there is continued impairment, further consultation with the shoulder orthopedic specialist is initiated. If plane film x-ray or MRI (to specifically define the persisting injury to the rotator cuff) has not been undertaken, they will be at this time. Relying on data from the physical therapist and imaging in conjunction with their physical exam and the patients pain presentation, the physician can ascertain the status of the shoulder joint and rotator cuff. At this time, the physician can lay out a plan of care for the patient.