Rotator cuff injuries and tear

Definition

¡  Any irritation or damage to the rotator cuff muscles or tendon is called rotator cuff injury.

¡  A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles.

Mode of injuries

¡  Forceful throwing of object with overhead action.

¡  Commonly seen in cricket and javelin throw players.

¡  Fall on a shoulder  and an attempt to lift a heavy weight 

¡  And an attempt to lift a heavy weight 

¡  Degenerative changes with advance age

Clinical features

¡  Severe acute pain and discomfort in the shoulder felt immediately.

¡  Patient unable to abduct the arm actively.

¡  Often pain is referred to the deltoid insertion.

¡  Weakness of rotator cuff muscle or affected muscle function.

Special tests

q Drop arm test (Codman’s test)

 For Rotator cuff injury

 q  Empty can test (Job test)

For Supraspinatous muscle

q  Spring back or lag test. (lift off sign)

v  Abdominal compression or belly press test.

For Subscapularis muscle

q  Lateral rot. Lag test (lag sign)

For Infraspinatous muscle

q  Teres minor test

For Teres minor

Differential diagnosis

¡  Adhessive capsulitis

¡  Bursitis

¡  Impingement syndrome

¡  Bicipital tendinitis

Conformation tests

¡  Special test positive

¡  MRI

¡  X-ray

Treatment

¡  Rest, immobilization and analgesics in case of 1° and even in 2° tear (partial)

¡  But in case of 3° tear (full, chronic) conservative method or by surgical repair.

¡   Preventive or postoperative physiotherapy rehabilitation.

Physiotherapy management  

1. For pain management

§       Icing

§        Moist heat

§       Cntrast bath

§       Iontophorosis

§       IFT

§       Mulligan taping (support and stability)

§       Kinesio taping (to reduce pain)

2. To improve mobility of the shoulder

Passive movement

Initially flexion and extension in side lying and abduction and adduction in supine lying  and than in sitting position.

Active assisted movements ( throught out full ROM)

Self assisted movements

Wall ladder exercise

Aquatic rehabilitation (hydrotherapy of pool activities)

Progressive resisted exercise

1. Manual resistance exercise
2. Exercise with dumbell
3. Exercise with theraband
4. Exercise with gym ball