Tag Archives: rotator cuff

Is Physical Therapy Effective After Rotator Cuff Tear?

shoulderptDr. Stickney, a Kirkland orthopedic surgeon, is an expert in shoulder injury treatment, total and partial knee arthroplasty, sports medicine, and more. 

Rotator cuff tears can occur from athletics such as baseball, weightlifting, competitive swimming or just over time with overuse and improper strength and flexibility. These shoulder injuries are extremely common, affecting at least 10% of people over the age of 60 in the United States – which equates to over 5.7 million individuals. Of the 5.7 million+ individuals who suffer from rotator cuff tears, fewer than 5% are treated surgically, and patients who undergo surgical repair experience a failure rate between 25 and 90%. What’s interesting though, is that patients with repair failures report satisfaction levels and outcome scores that are nearly indistinguishable from those whose repairs are intact. Because most of these surgical patients undergo postoperative physical therapy, it is logical to assume that physical therapy may be responsible for the improvements in outcome. A multicenter prospective cohort study conducted by the MOON Shoulder Group and published by Journal of Shoulder and Elbow Surgery takes a closer look.

To conduct the study, 452 patients with atraumatic full-thickness shoulder rotator cuff tears provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments. Physicians also recorded physical examination and imaging data. Patients then began a physical therapy program developed from a systematic review of the literature and returned for evaluation at six and 12 weeks.

At those visits, patients could choose one of three courses: 1. Cured (no formal follow-up scheduled), 2. Improved (continue therapy with scheduled reassessment in six weeks), or 3. No Better (surgery offered). Patients were also contacted by telephone at one and two years to determine whether they had undergone surgery since their last visit and a Wilcoxon-signed rank test with continuity correction was used to compare initial, six-week, and 12-week outcome scores.

The results? Patient-reported outcomes improved significantly at six and 12 weeks and patients elected to undergo surgery less than 25% of the time. The patients who did end up deciding to have surgery generally did so between six and 12 weeks, and few had surgery between three and 24 months.

This study suggests that nonoperative treatment using this physical therapy protocol is indeed effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for two years.

If you have questions about treatment options for your shoulder injury or would like to make an appointment, please contact our office.

Causes and Treatments of Common Shoulder Injuries

shoulder painThe shoulder is a complex joint that facilitates the movement of the arm . Without this crucial joint, the most basic movements of the arm and hand would be impossible.

Think about the mobility that the shoulder affords the arm and hand. Although it is crucial for our daily activities, this movement often comes with a price as we age. Over time the shoulder joint can wear down causing increasing pain.

Due to the complexity of the joint, there are many categories that shoulder injuries fall under:

  1. Fractures
  2. Instability
  3. Arthritis
  4. Soft tissue inflammation and tears

Fractures

Shoulder fractures usually consist of a complete or partial break of the collarbone (clavicle), upper arm bone (humerus), and the shoulder blade (scapula). This type of injury can range from minor to severe depending on how the injury was suffered. Shoulder fractures are accompanied by severe pain, swelling, bruising, and decreased mobility.

The most common causes of these fractures are car accidents, contact sports injuries, and falls. While the treatment of the injury depends on the severity and patient type, the most common treatment is a sling, worn for 8 weeks. However, surgery may be required in more severe cases. In all cases extensive Physical Therapy is needed after healing to regain strength and mobility.

Instability

The shoulder is the most mobile joint in the body, putting it at high risk for instability. This phenomenon occurs when the upper arm bone comes out of the shoulder socket. Once this happens the shoulder may “catch” or become completely dislocated. Instability in younger patients can be a huge problem that creates recurrent issues if the problem is not addressed properly. As the ligaments around the shoulder have been torn during the dislocation, instability can persist if the ligaments do not heal. Recurrent dislocations can occur, causing pain and ultimately arthritis.

Shoulder instability usually happens as a result of a specific sports injury or trauma. There is very little possibly that it will occur without a specific injury. Treatment usually involves the wearing of a sling and extensive physical therapy. However, if the muscles are not strengthened, and dislocation continues, surgical stabilization may be necessary. New minimally invasive arthroscopic shoulder surgery can fix the problem quickly with a shorter recovery period.

Arthritis

The most common type of shoulder arthritis is osteoarthritis. This type of arthritis comes from extreme wear and tear and/or age. At the onset of shoulder arthritis, people try to minimize the pain by using the shoulder less. Although this decreases the pain, immobility for too long leads to tightening of the joint resulting in even more pain.

Osteoarthritis is extremely common, and is often the result of genetics or family history. Sports or work injuries and/or chronic wear and tear are also common causes. Previous shoulder injuries, like rotator cuff tears, and multiple dislocations can cause painful shoulder arthritis as well.

So, how do you relieve this pain? Most effective pain management comes from lifestyle changes, range-of-motion exercises, physical therapy, and rest. Your doctor may also prescribe some pain reduction medications like ibuprofen. Only in the most extreme cases will you be advised to have joint replacement. If you do require joint replacement, make sure to talk to your doctor about minimally invasive shoulder replacement.

Tendon inflammation and tears

Tendon injuries and tears of the shoulder are extremely common. Overuse can easily cause tendonitis or bursitis; both of which inhibit shoulder mobility and cause extreme pain.

Although there are many tendons in the shoulder, the most commonly injured are the rotator cuff tendons and or the biceps tendon. Rotator cuff strains or partial tears may progress to get worse due to aging blood supply and or impingement. Impingement is usually due to bone spurs pinching the tendon during motion.

The best way to prevent an inflamed shoulder Tendon from tearing is rest. Avoiding activity will allow the tendons to heal, reducing the risk of a tear. Anti-inflammatory medications or injections may be prescribed along with rest and physical therapy. However, if these measures do not work, the Tendons can tear. Once this happens, Therapy is less successful and surgery may be advised.

Nobody wants to suffer from shoulder pain. So, if you find yourself suffering from any one of these shoulder injuries come see Dr. Stickney. He will provide you with the best treatment, tailored specifically to your injury and condition. Don’t wait, come see Dr. Stickney and get back to your normal routine faster.