The shoulder - one of the common peripheral joints that we see in clinic.
And the most common shoulder issue that we see is something to do with the rotator cuff - this is what GP's and many health practitioners say. But it doesn't always have to do with the rotator cuff - a recent study showed that 96% of asymptomatic subjects (no pain or limitation in movement) had something wrong with the rotator cuff on an ultrasound - but did not know about it. So - sometimes it is the rotator cuff - but most of the time it is due to other factors.
What is the rotator cuff?
The rotator cuff is important in normal movement of the shoulder. It helps to keep the ball centred in the socket with movement. There are 4 muscles in the rotator cuff - so even if there is injury to one of these, there are other muscles to step up and help.
What can go wrong with the rotator cuff?
When it comes to the rotator cuff, there are a number of things that can happy. Commonly this is a tear. These tears can be partial thickness, full thickness or a rupture. For full and partial thickness tears (and even ruptures) - many people fear that they will lose all shoulder movement but this is not the case.
What is the best way to manage these tears?
Check out below to see what the evidence says when it comes to management of these conditions!
Goldberg et al. (2001) - Outcome of nonoperative management of full-thickness rotator cuff tears
- 46 patients with full-thickness rotator cuff tears
- Conservative treatment and follow-up for at least one year
- No manual therapy, only patient education and a home program of gentle stretching and strengthening
- 60% of patients experienced improvement in general health and physical function scores (this is just with a home program - so with supervised rehab we can expect this to be higher).
- Improved ability to sleep on the affected side and the ability to place the hand behind the head improved significantly
- Suggests the effectiveness of exercise as treatment for cuff tear
Kuhn et al. (2013) - Effectiveness of Physical Therapy in Treating Atraumatic Full Thickness Rotator Cuff Tears. A Multicenter Prospective Cohort Study
- 381 participants, atraumatic rotator cuff tear, condition for a minimum of two years
- Significant improvements in patient-reported outcomes with 6-12 weeks physiotherapy: shoulder mobility/manual therapy and rotator cuff exercises
- Improved patient reported outcomes in function and movement
- Lower rate of surgery after physical therapy in the treatment of atraumatic full thickness rotator cuff tears
- Those who choose to have surgery will usually elect to do so in the first 12 weeks, thereafter, participants are unlikely to elect for surgery
- Shoulder mobility and rotator cuff exercises can delay surgery and improves quality of life, pain and functional living measures
Kukkonen et al. (2014) - Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results
- Compared three different treatment groups treating symptomatic non-traumatic tears of the supraspinatus tendon
- physiotherapy only
- combined acromioplasty (surgery) and physiotherapy
- combined rotator cuff repair, acromioplasty (two different techniques in the same operation) and physiotherapy
- 167 shoulders evaluated at one year
- No differences between any of the groups - surgical treatment was no better than conservative therapy
- Conservative treatment should be used as it has the SAME outcomes as surgery - with much less risk and cost
Take home messages
- Physiotherapy improves pain, function, QoL
- Physiotherapy can delay surgery
- Conservative treatment should be used as it has the SAME outcomes as surgery - with much less risk and cost
So - shoulder pain and ultrasound scans don't need to be feared. If managed appropriately and early, great results can be achieved!