Given that October is Physical Therapy month I wanted to take a time to write about a question patients frequently ask relating to shoulder pain, rotator cuff tears and why am I in therapy if my rotator cuff is torn?
First off let me talk about the shoulder as a joint. It is a very poorly constructed joint with respect to stability, however it is a very functional joint in that we have tons of motion at the shoulder joint. Unfortunately that unstable nature of the joint predisposes it to injury and further increasing the likelihood of injury is life choices (recreational and professional).
Depending on how you look at it the shoulder complex can be comprised of two joints, the glenohumeral joint (what we classically think of when referring to the shoulder) and the scapulothoracic joint. For the average person this is likely of little importance, but is of utmost importance when attempting to successfully rehabilitate the various types of shoulder injuries. It is very important for both joints to work in unison for proper shoulder function or to prevent injury. However as we are talking about the scenario of a rotator cuff tear and do I need surgery, let’s focus on the glenohumeral joint.
The glenohumeral joint consists of the glenoid fossa (a very shallow scoop) and the humeral head (a large ball). Being I’m a golfer I’ve always preferred the analogy of the shoulder being like a golf ball and tee when educating my patients. It is your rotator cuffs job to keep this large oversized “ball” (humeral head) balanced on a small shallow “tee” (glenoid fossa). The rotator cuff is 4 muscles whose main job is to work together to keep that golf ball balanced on the tee, oh did mention it also elevates and rotates the shoulder.
While not everyone will succeed with physical therapy for a rotator cuff tear, research demonstrates and favors successful and good outcomes with conservative care. Physical therapy will consist of restoration of motion, joint mechanics, motor programming and strength and stabilization exercises. The rehab process helps address each of these components to allow individuals to return to normal and hopefully pain free function of the shoulder without surgery.
If rehab doesn’t work the good new is that following rotator cuff repairs patients have a >90% satisfaction rate. However rehabilitation following rotator cuff tears can be long and costly. Click for more reading and articles I think deserve more attention in our medical field. They are from the website of Mike Reinold a very well respected physical therapist and individual in the health and wellness field. He said it better than I just attempted to and addition his articles included pictures and representations to better understand.