Rotator cuff injuries are extremely common and can be caused by dislocation, repetitive trauma, tendon degeneration, and the normal ageing process. Everyone has probably heard of their rotator cuff but most probably don’t know what it actually is! Our rotator cuff is a group of four muscles that work together to provide our shoulders with dynamic stability.
If we have a tear or irritation through these muscles it can lead to reduced function and pain. Symptoms often include; pain with sleeping on that shoulder, difficulty lifting overhead, or completing overhead activities and discomfort that can radiate down the outside part of the arm. However, it is important to realize that only around 1/3 of full-thickness rotator cuff tears are actually painful. This means that people can have an injury and have no issues at all and the recovery with conservative management (physiotherapy) has very favourable outcomes!
What Can we do in the short term?
In the short term, we want to do what we can to try to reduce your discomfort. Your physiotherapist may try a combination of different things! These might include:
Taping your shoulder (see video) – this is used to help support and offload the shoulder while it is painful.
Hands-on treatment around the shoulder as well as teaching you some self-release techniques for the home to help reduce your symptoms
Activity modification! This is a big one in the beginning because in order to settle a grumpy shoulder we need to change what we are doing to allow for this!
Muscle activation and light loading. In the early days, your Physio may give you some light movement or control exercises to start getting everything around your shoulder working nicely together without irritating it too much.
What can we do in the long term?
Once your shoulder pain has settled a little we want to begin to LOAD it. Regardless on the degree of the injury to your rotator cuff everyone shoulder undergo a comprehensive strengthening program that is guided by a health professional before considering more invasive options. This will require commitment to a graded strengthening program that should be continued for at least 3 months.
Do I need surgery or cortisone?
No, you do not NEED surgery or cortisone. As indicated above everyone should undergo at least 12 weeks of conservative management that includes a comprehensive and gradual strengthening program. Research shows that around 80% of people experience success with conservative management and that there is minimal difference in outcomes 5-years following surgery compared to those who didn’t have surgery.
In fact, This is really the only way to know if you actually NEED surgery. Surgery won’t fix the way you move or the strength of your muscles which is often the reason why you are in pain in the first place! Rehab and strengthening will fix this, and more often than not it will solve your problem and you can avoid surgery!
The same rules apply to cortisone. It isn’t targeted at helping improve your function, strength, and capacity around the shoulder. It can provide some symptomatic relief early on but the long term outcomes are no better than if you didn’t have it at all!
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