The role of physiotherapy
The rotator cuff - what is it?
The rotator cuff is the collective term for the group of muscles and tendons that surround the shoulder. It attaches the humerus (upper arm bone) to the shoulder blade (scapula).
There are four rotator cuff muscles which provide stability and control of the shoulder, each controlling a specific arm movement:
Supraspinatus – lifts your arm sideways
Infraspinatus – turns your arm outwards
Teres Minor – turns your arm outwards
Subscapularis – turns your arm inwards
When one or more of the rotator cuff tendons is torn, the tendon can become partially or completely detached from the head of the humerus. A torn rotator cuff can make many daily activities such as reaching, lifting, combing your hair or getting dressed, painful and difficult to do.
What causes a rotator cuff tear?
There are two main causes of rotator cuff tears: injury and natural degeneration. Injury can occur by a sudden or excessive loading such as lifting or pulling something heavy with a jerking motion. It can also occur through repetitive use, particularly in occupations that involve overhead work, and in sports such as tennis.
The role of physiotherapy
Physiotherapy plays two roles:
1. Part of a non-surgical treatment plan.
2. Part of the recovery process following surgery.
For many patients, non-surgical treatment can relieve pain and improve shoulder function. Options include rest, avoiding activities that aggravate, medications for pain relief and physiotherapy to improve range of movement, strength and to gradually restore function.
If pain does not improve, or in the case of acute traumatic injury (where the tendon is fully ruptured (torn), surgery may be the necessary option.
Although most tears occur in the supraspinatus tendon, any of the tendons can be injured. Surgery to repair a torn rotator cuff usually involves re-attaching the tendon to the head of humerus.
Following surgery, a brace is worn for six weeks to protect the repair and physiotherapy is necessary to regain shoulder mobility. Once out of the brace, the shoulder can resume active movement and then strengthening occurs under the guidance of the physiotherapist.
The physiotherapist will instruct and monitor a home programme of exercises until function is restored, which can take up to a year to achieve. A well-motivated patient, good repair of the tendon and a structured physiotherapy programme can usually gain a very good result.
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