Dysfunction of scapulohumeral rhythm and a compensatory shoulder shrug may be observed during active abduction and elevation. Finally, patients with long-standing rotator cuff tears may present with obvious atrophy, with muscular wasting in the supraspinatus also commonly associated with a concomitant infraspinatus tear.
Examination of the athlete should include: History including, palpation. Knowledge of the natural history of rotator cuff tears is important when making treatment decisions to achieve best outcomes for patients.
MRI scan – gold standard to assess integrity of the rotator cuff tendon, musculature, labrum and articular cartilage. .
Diagnostic ultrasound – Dynamic assessment of rotator cuff injury.
A recent review by Edwards et al. (2016), provided an evidence-based 4-phase exercise protocol for the conservative management of rotator cuff injury.
1. Range of motion
4. Advanced strengthening/proprioception. .
- Eliminating initial pain
- Improving mobility
- Addressing stability, strength, power, and neuromuscular control
- Correcting identifiable issues along the kinematic chain. .
OUR VIEWS ON THIS STUDY :
- Patients with chronic rotator cuff tears may develop symptoms when they are more active, or that a higher activity level contributes to the development of rotator cuff lesions.
- Shoulder activity level is correlated with age and gender in patients with symptomatic or atraumatic rotator cuff tears, it does not correlate with the size or severity of the tear. It may be possible that increased activity which helps patients to develop compensatory kinematics and strength, which may prevent or minimize symptoms.
- If rotator cuff tears spreading into the posterior cuff then it gradually disrupt the balance of muscular forces whihc impacting GHJ stability and affecting optimal function. Restricted range of motion in external rotation and tears extending from the supraspinatus to the infraspinatus tendon negatively affect the outcome following conservative treatment.
- Depending on the size and duration of injury conservative trteatment should be consider.
- Better understanding of who will or who will not respond well to conservative treatment prior to deciding and starting conservative is of utmost important.
The influence of tear size on the success of conservative management is not known.
Don’t miss anything! Turn on Post Notifications Next Up: 2. Early Rehabilitation 3. Intermediate Phase 4. Advanced/Late Stage Rehabilitation 5. Future Directions and Conclusions
- weiss et al. 2018. Management of Rotator Cuff Injuries in the Elite Athlete. Cur Rev Musc Med.
- Edwards et al. 2016. Exercise rehabilitation in the non-operative management of rotator cuff tears