R
One can strain ("Impingement"), partially or fully tear, or have a degenerative condition of the rotator cuff. The cuff comprises the conjoined tendons of four muscles that intrinsically stabilize the shoulder joint. Falling on an outstretched arm, overuse and the effects of aging are causative factors. Chronic imbalance amongst the muscles can produce pain over time. There is often difficulty raising the arm overhead. The diagnosis is usually clinical. It is a common condition after 40 years of age. If a specific tear is suspected by the surgeon, or pain persists despite diligent physical therapy, an MRI may be indicated. A rotator cuff strain is often point tender at the shoulder with possibly some referred pain into the upper arm. There is rarely numbness/tingling. A Physical Therapist can assess any influence on the pain pattern coming from the neck, which often refers pain to the arm. Pain with raising the arm especially overhead is classic. This condition can often lead to losing range of motion(ROM), which needs attention immediately. Treatment comprises the preservation of ROM, rebalancing of the four rotator cuff muscles(by selective stretches and strengthening exercises) and optionally, some modalities. Ideal posture is essential to rotator cuff health. Proper arm-shoulder blade mechanics during movement can be assessed by the therapist. Rehab is critical to avoiding recurrence or worsening of this commonly chronic problem.
Recalcitrant pathology should be assessed by a surgeon. The post-op rehab after a rotator cuff repair is lengthy and arduous. In most cases, the arm is kept in a sling for about 4-6 weeks, during which time only passive and limited movement is allowed. Only at about three months can strengthening exercises be started. The rehab should be closely monitored by the therapist.
|
