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Rehabilitation of Partial-thickness Rotator Cuff Tears

A 2009 communication on research of the injured shoulder by University of Alberta professor Judy Chepeha summarized the state of therapy for the non-surgical rotator cuff injury. These injuries represent an increasingly prevalent source of occupational restriction. Typically, the presentation is characterized by pain with above shoulder movements, shoulder weakness and a decreasing ability for day to day activities.

University of Alberta Rehabilitation Medicine researchers reviewed several studies that involved this patient population including randomized controlled trials (RCT) trials and cohort studies. The studies tended to include several treatment modalities in the same investigation and this may mask the real effect of some modalities. However, most notably, retraining muscles that act in concert with the rotator cuff (deltoid, pectorales and latissimus dorsi) had a statistically significant beneficial effect in restoring function when compared to no rehabilitation intervention. In another retrospective cohort study, a combination of steroid injection, physical therapy treatments and oral medication had superior results to physical therapy only.

This was consistent with the findings of yet another systematic review performed by Dewhurst (2010) of RCT trials. These trials showed that strengthening the muscles that control the scapula had significant beneficial effects on rotator cuff impingement. Vas et al. (2008) also demonstrated that a combination of single point acupuncture and physical therapy treatments had significant reductions in pain, improvement in functional abilities and reduction in medication use in this patient population. Similar results were noted in a blinded RCT that showed therapeutic exercise to be superior to electro-physical modalities in the treatment of rotator cuff tendinitis.

These studies are consistently demonstrating the value of a therapeutic exercise approach. The approach may be combined with steroid injection, in addressing the limitations produced by the partially torn rotator cuff when surgery is not an option.The findings indicate that an assertive approach to rehabilitation of these clients should have therapeutic exercise as its centre.

References
Dewhurst A. Musculoskeletal Medicine, 2010. 32(3): 111-116
Kuhn J.E. J Shoulder Elbow Surg, 2009. 18: 138 – 160
PT Alberta Newsletter, November, 2011
Vas J., et al. Rheumatology, 2008. 47: 887-893
For feedback contact Hercules Grant PhD at hercules@ualberta.ca