Review of Treatment for Rotator Cuff TearsIn this article, orthopedic surgeons from Harvard Medical School provide a review of surgical and nonsurgical treatment of rotator cuff tears (RCTs). The authors review shoulder anatomy and biomechanics and the stages of tendon healing to help the reader understand the decision-making needed in choosing the right treatment for each patient.
Nonsurgical conservative care is usually advised first. In the acute phase, physical therapists may use modalities such as electrical stimulation, ultrasound, and/or ice to manage early painful symptoms. A special kind of soft-tissue work called transverse friction massage is used to help realign the fibers of the healing tendon.
Strengthening exercises combined with joint mobilization have been shown to work better than exercise alone. The therapist also helps reduce stiffness and scarring in the shoulder. If conservative care fails and the patient needs surgery, the treatment isn't wasted because postoperative recovery is better in a supple shoulder.
When surgery is needed, the tear is repaired and the shoulder is immobilized. Instead of a plain sling, studies have shown an abduction immobilizer is best. A sling with a firm support under the arm abducts the shoulder (moves the arm away from the body). This position allows for better blood flow to the rotator cuff and decreases tension on the repair.
The authors present four phases of postoperative rehabilitation. An indepth discussion of each phase is included. The length of each phase, the goals and precautions, and activities to be done are presented. Phase 1 starts with passive exercises. Phase 2 progresses through active exercises. Phase 3 includes strengthening exercises. Phase 4 is advanced training.
Peter J. Millett, MD, MSc, et al. Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach. In Journal of the American Academy of Orthopaedic Surgeons. October 2006. Vol. 14. No. 11. Pp. 599-609.
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