Treatment Options for Rotator Cuff injuries

Once your medical professional has diagnosed your condition, they will be able to recommend the most effective treatment for your Rotator Cuff injury. There are a variety of options available depending on the severity of your injury.

Inflammation, one of the first symptoms of Rotator Cuff damage, is normally a result of overuse of an area on your shoulder, a traumatic injury to your shoulder, Rotator Cuff Tendonitis/Bursitis, a Rotator Cuff impingement or a Rotator Cuff tear. The preliminary treatment for most of these conditions generally starts with non-operative options. If you fail to see improvement with these, your physician may recommend a surgical option.

Non-surgical Rotator Cuff Treatment options

Your initial treatment should involve decreasing any swelling, relieving any pain and stress on the Rotator Cuff, correcting any biomechanical dysfunction, and then restoring strength and mobility to your injured shoulder. It is also very important to follow any instructions you receive from your physician.

To decrease inflammation and relieve pain for a chronic or diagnosed Rotator Cuff injury, adhere to the URICE philosophy within the first 48 - 72 hours:

Ultrasound around your injured shoulder for 5 minutes, 3 times per day. This is best accomplished with a personal, therapeutic ultrasound device.

Rest your arm and limit your overhead activity (if you are able to move your arm)

Ice the area 2-3 times/day for approximately 15 - 20 minutes at a time (do not apply ice directly on your skin, rather wrap it in a cloth or towel)

Compress the area if possible by adding light pressure to minimize swelling (make sure the compress is snug; if too tight it could cause numbness, tingling or more pain).

Elevate the injured area above chest level to relieve the pressure from swelling and allow fluid to drain from the injured part.

If you do not have access to ultrasound therapy, or you have experienced an acute injury and/or have not been diagnosed, adhere to the RICE philosophy within the first 48 - 72 hours.

Ultrasound therapy is a great therapeutic option to decrease inflammation, pain and soft tissue (muscle, connective and nerve tissue) damage experienced with a Rotator Cuff injury. This can be received using a portable, home ultrasound device (self-administered) or by seeing a physiotherapist. The treatment is easy, painless, and generally requires between 5 - 10 minutes. It is based on a form of deep heat therapy which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and medicinal conductive gel that are used together in a slow, circular motion on your skin over the injured area. You may experience a slight tingling or warm sensation during the process as a result of the gel; this enhances the therapeutic effects of ultrasound (Phonophoresis).

Ultrasound therapy increases collagen and tissue elasticity, which in turn promotes circulation (blood flow) and brings oxygen and nutrients to your injured area. This cleans your tissue by getting rid of cell waste products and allows your injury to heal correctly. If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to improve your range of motion by breaking down any scar tissue that may form in the injured area. Ultrasound waves penetrate deep into your tissues, relax your muscles, decrease chronic inflammation and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

Pain and Anti-inflammatory (NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties. Some health professionals have also recommended natural supplements such as Glucosamine, MSM or Hyaluronic Acid to help strengthen the injured tissue. The use of ultrasound in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal your tennis elbow quicker.

Once the initial swelling has decreased, you can provide pain relief and improve your arm function by using a hot compress to increase the blood flow to the area. Gentle massage around the injured area or small shoulder movements (if not painful) will also help increase blood flow, oxygen and nutrients and will prevent stiffness. To increase your comfort and prevent further damage, you may want to immobilize your arm by using a shoulder sling or brace to avoid unpredictable movements.

If pain and inflammation persist, you can see your physician to investigate cortisone/steroid injections or topical medications, which may help reduce swelling and inflammation. However, these should be used with caution and never in conjunction with ultrasound therapy

Physical Therapy is a beneficial way to help decrease pain in the soft tissues, restore atrophied muscles and improve shoulder strength and mobility. The type of physical therapy and the duration will be dependent on your injury.

Once your pain starts to diminish, a physiotherapist will also set up an individualized Rotator Cuff strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines. Individuals will often lift weights on their own, to try and build up their shoulder strength. However, in doing so, they can do more damage to their shoulder. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For best, long term results use ultrasound in conjunction with physical therapy and an exercise program.

During your recovery, you may have to modify and/or eliminate any activities that cause pain or discomfort in your Rotator Cuff area until your pain and inflammation settle, and you gain more mobility and strength in your shoulder. Often you will notice a great improvement within 6 to 12 weeks; however it can take months to return to normal. The more diligent you are with your rehabilitation, the faster you will see successful results.