The shoulder is the most mobile joint in the body, and the rotator cuff muscles help stabilize it during movement. This mobility, however, frequently results in rotator cuff injuries, which can occur both with traumatic events--including sudden movements, such as with kayaking or throwing a ball--or chronic use, such as work that requires repetitive reaching, especially overhead reaching. The University of Washington Department of Orthopaedics and Sports Medicine says that rotator cuff injuries "are the most common cause of problems of the shoulder." This very frequency has also spawned a host of treatment options.
Acute Injuries
As with all traumas to muscles or tendons, injuries to the rotator cuff should be treated for 48 to 72 hours with the R.I.C.E. process: Rest the injured shoulder, and apply ice and compression while elevating the arm. At the same time, call your doctor to make an appointment for an exam to find out the extent of your injury.
Conservative Treatments
Rotator cuff injuries are frequently treated conservatively. Conservative treatments include resting the arm, perhaps using a sling for part of the day and avoiding overhead activities; using anti-inflammatory medications, such as ibuprofen or acetaminophen; and possibly getting a steroid injection into the affected shoulder to reduce inflammation and allow for healing. Once the acute phase of the injury is over, physical therapy and other exercise programs help you regain strength and range of motion in your arm. According to the online Sports Injury Clinic, 40 to 90 percent of rotator cuff injuries are successfully treated conservatively.
Rotator Cuff Surgery
Torn fibers from a rotator cuff retract, and the contractions of the muscles prevent them from returning to their former position. Over time, other changes to the muscle and tendons make it less likely to have a good outcome after an injury. Therefore, say the specialists at shouldersurgery.com, if you're diagnosed with a complete tear of your rotator cuff, having surgery sooner is better than waiting. The type of surgery your doctor recommends depends on the injury to the rotator cuff.
The American Academy of Orthopedic Surgeons lists three basic surgical options: Arthroscopic repair, mini-open repair and open repair. Some surgery may be done as out-patient surgery; for others you need to be hospitalized.
Studies done at Henry Ford Hospital indicate those who have surgery to repair a rotator cuff tear may not fully recover their pre-injury motion and strength, but the pain relief and improved use of the arm appear to more than make up for this. This is confirmed by a paper presented at the 2003 American Academy of Orthopedic Surgeons (AAOS) Annual Meeting and cited on the AAOS Web site. This meta-analysis determined that satisfaction rates for pain relief, improved range of motion and increased strength after rotator cuff surgery are as high as 98 percent.
If you choose to have a rotator cuff repair, the AAOS says that surgery alone won't do the trick. You must also fully commit to your rehabilitation.
Rotator Cuff Rehabilitation
Whether you choose conservative or surgical treatment of your rotator cuff tear, rehabilitation is necessary to achieve the best outcome. If you don't choose surgery, your doctor may recommend that you sometimes use a sling to rest your arm; your arm may also be immobilized for a period of time following rotator cuff surgery. However, it's important to keep your shoulder from becoming weaker or stiffer, so your doctor will also prescribe physical therapy. The therapist will help you plan a treatment program, starting with passive range of motion exercises. You gradually progress to more active exercises to help you regain strength. It may take up to six months to complete your rehab program.
