Rotator Cuff Injury
Rotator cuff injury is the most common problem to affect the shoulder; accounting for 4.5 million physician office visits per year. (1) Injuries range from a mild strain of a single tendon to complete rupture of multiple tendons.
One critical key to successfully managing shoulder pain includes understanding how improper scapular motion leads to impingement and ensuing tendon damage. Neer reported that “impingement” precedes 95% of chronic rotator cuff tears. (2). And subsequent studies demonstrated that 100 percent of patients with shoulder impingement demonstrate improper scapular motion, i.e. scapular dyskinesis. (3) (To learn more about Scapular Dyskinesis, check out our 15 minutes to excellence webinar.)
Research published earlier this year confirms that successful management does not always consist of re-stitching tendons or carving bone; the paradigm is shifting toward correcting the underlying biomechanical faults:
“The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and (conservative) therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for (conservative) therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management including exercise may, in selected cases, be a treatment alternative to surgical repair.” (4)
A related new study shows that conservative care is very effective:
“Findings from published high quality research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness rotator cuff (RC) tears and atraumatic full thickness rotator cuff tears.” (5)
Conservative providers must however, remain vigilant for presentations that may require surgery. Bartolozzi (6) identified three factors associated with a poor prognosis for conservative management of rotator cuff injury:
- full thickness tears greater than 1 cm
- symptoms lasting more than one year
- functional impairment/weakness
Additionally, a study published in Clinics in Sports Medicinesuggested that ruptures and larger tears (> 1 cm) in younger populations may be best addressed surgically before irreversible retraction. (7)
As chiropractors, we are equipped with the ability to be the best choice for managing shoulder pain. It is our responsibility to continually hone our skills and knowledge so that we may maintain our rightful position as effective point of entry physicians. Visit ChiroUp.com today to review the current “best practice” management of rotator cuff pathology, or any of the other 90 diagnoses.
1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 2007;455:52-63
2. Neer CE III. Impingement lesions. Clin Orthop. 1983;173:70-77.
3. Warner J.J.P, Micheli L.J, Arslanian L.E, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. Clin Orthop Rel Res. 1992;285:191-199.
4. Edwards P,et al. Exercise rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. Int J Sports Phys Ther. 2016 Apr;11(2):279-301.
5. Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016 Jun;23:57-68.
6. Bartolozzi A, Andreychik D, Ahmad S: Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res 1994, 308:90-97.
7. Tashjian RZ Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012 Oct;31(4):589-604.