Introduction
One of the most common causes of pain and dysfunction in the shoulder complex is full thickness rotator cuff tears, which are becoming more common as the population ages. The significant disability, poor quality of life, and high cost of using healthcare resources have made chronic rotator cuff pathology a topic of interest. Evidence on the treatment of rotator cuff tears has so far yielded conflicting findings. Some authors believe that surgical repair of rotator cuff tears offers greater success than non-operative therapies, whereas other researchers have stated that non-operative treatments offer results that are equal with surgical repair. Opponents of surgical intervention, claims that rotator cuff tendon repair, particularly when done early in the disease process, may change the pathogenic mechanisms of rotator cuff disease and protect or even reverse the progression of tears, tissue deterioration, biceps involvement, and glenohumeral joint (GHJ) degeneration. Read the article to know more.
What Is a Rotator Cuff Tear?
According to definitions, an acute rotator cuff tear is one that involves an injury or trauma, typically manifests in people who have never previously experienced shoulder symptoms, and causes pseudoparalysis of the shoulder. According to the mechanism of the injury, rotator cuff tears can be categorized as acute, chronic, or a mixture of both (acute on chronic). Severe rotator cuff tears frequently result from the tendon's progressive degeneration, which develops over time and is typically brought on by a number of factors including overuse, an inadequate blood supply, and other physiological ones.
Trauma can exacerbate chronic cuff tears, which may not even be symptomatic. Rotator cuff tears fall into one of two broad categories: partial-thickness or full-thickness, depending on the mechanism of the injury. In general, partial-thickness tears occur more frequently than full-thickness tears (13 % versus 7% prevalence).
What Is the Prevalence?
The third most frequent musculoskeletal ailment indicated to primary care doctors in health care settings is shoulder pain. In developed nations, general practitioners anticipate that 1 % of the adults will seek treatment for shoulder pain each year. While 65 to 70 % of all shoulder pain is thought to be caused by the rotator cuff tendon, 5 to 40 % of individuals without shoulder pain are thought to have full-thickness rotator cuff tears.
What Are the Signs and Symptoms?
The clinical presentation of an individual with a diagnosed rotator cuff tear varies and dictated by a number of variables including the location and size of the tear. Some patients present without significant pain, symptoms and or dysfunction, while others report severe pain and demonstrate loss of strength and function. However, the reason why some tears may remain asymptomatic is not fully understood. Patients with a symptomatic rotator cuff tear typically present with shoulder pain and cuff weakness. Strong indicators of supraspinatus tendon tears include ongoing pain and a painful arc (pain during abduction between 70 and 120 degrees). Additionally, these patients frequently exhibit positive impingement signs, a lack of active shoulder abduction and elevation, and weakness and pain reproduction during resisted abduction or external rotation.
Superoposterior tears exhibit a reduction in active range of motion, a weakness in external rotation, and a positive lag sign, whereas subscapularis tears may exhibit a reduction in active range of motion, a weakness in internal rotation, and an unusual "lift off" sign. In patients with massive rotator cuff tears, a recent clinical study showed that tears that extend beyond 50 percent of the subscapularis tendon raised the likelihood of pseudo-paralysis. Active abduction and elevation can result in scapulohumeral rhythm dysfunction and a shoulder shrug as a protective mechanism. In addition, supraspinatus muscle wasting is frequently accompanied by an infraspinatus tear in patient populations with long-standing tears in the rotator cuff, who may also exhibit obvious atrophy.
What Are the Non-operative Managements of Rotator Cuff Tears?
Non-operative interventions proponents contend that for some patients, treating functional as well as clinical deficits with conservative method is sometimes successful in pain management and symptoms, offering a respectable substitute for surgery. Exercise rehabilitation is generally the keystone of this conservative management plan because it is the primary goal of treating a rotator cuff tear through conservative management to reduce pain and improve function. A thorough exercise program has been provided for the conservative management of ruptured rotator cuffs based on the literature that is currently available and the authors' clinical experience. Littlewood et al. reported that exercise, whether performed at home or in a clinical setting, decided to offer superior outcomes over no treatment or a placebo and had no difference in outcomes when compared to surgery or multimodal physiotherapy.
This implies that the exercise aspect of physical therapy is essential in the management of these tears, and by 12 weeks, the majority of exercise protocols should have produced clinically significant changes in patient-reported outcomes. Similar to this, according to a systematic review by Ainsworth and Lewis, exercise therapy had a positive impact on patients with symptomatic full thickness rotator cuff tears when it was incorporated into a treatment plan. Exercise may have a number of different effects, despite the fact that the exact cause of its positive effects is unknown. This could include its potential impact on pain management, ability to treat functionally damaged rotator cuff tendons and muscles, the placebo effect, muscular compensation for inadequate movement strategies, and a decrease in kinesiophobia and patient uncertainty about whether the arm should be moved. The term "mechanotherapy" has also been used to describe how highly monitored loading of tendons may promote tissue remodeling and repair. It is suggested that cells have the capacity to react to mechanical stimuli and transform the stimulation into a cellular response to facilitate tendon healing.
Conclusion
Exercise is increasingly being used to treat and manage rotator cuff tears, including partial and full thickness tears, by addressing the drawbacks and functional deficits that are relatively common in patients with symptomatic shoulders. It is crucial to realize that the likelihood of a successful outcome from exercise rehabilitation will depend on patients response to treatment and the recurrence of symptoms.
