Managing Rotator Cuff Tendinitis and Tears with Physical Therapy

Physical therapy is an effective treatment for rotator cuff tendinitis and the management of rotator cuff tears to address pain and restore range of motion, muscle strength, and coordination. Rotator cuff tendinitis involves inflammation of the rotator cuff tendons, which causes shoulder pain and swelling and can lead to a partial or full tear of rotator cuff tendons. Physical therapy is recommended as the first line of treatment for rotator cuff injuries and is critical if surgery is necessary. Using a progressive exercise rehabilitation program, the physical therapist works to restore full pain-free range of motion, flexibility, muscle balance, and shoulder and scapular muscular control and stability in the patient for a successful return to daily activities.

 Anatomy of the Rotator Cuff

The rotator cuff is made up of a group of four muscles and their tendons that provide stability to the shoulder joint, rotate the shoulder, and allow the arm to lift above the head. The tendons attach the rotator cuff muscles to the shoulder blade (scapula) and upper arm bone (humerus).  It is called the rotator cuff because the four tendons merge together to form a cap or hood around the head of the humerus.

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What is Rotator Cuff Tendinitis?

Rotator cuff tendinitis occurs when the tendons of the rotator cuff become irritated and inflamed. As the tendon is continually irritated, it can begin to break down, causing shoulder pain and swelling. Tendinitis can be caused by repetitive arm movements and overhead shoulder motions. Those that engage in occupations and sports that require significant overhead movement are at a higher risk of developing this condition, such as hairstylists, painters, baseball players, and swimmers.

Rotator cuff tendinitis can also result from wear and tear over time and the aging process as tendons begin to thin and degenerate. Weakness and muscle imbalances in the shoulder blade, tight muscles and tissue around the shoulder joint, and poor posture can also contribute to the development of this condition.

How do Rotator Cuff Tears Occur?

A rotator cuff tendon can tear due to an acute trauma such as a fall or lifting a heavy object or from chronic tendinitis that leads to a slow-developing tear. Rotator cuff tears can be partial thickness or full thickness. A partial tear occurs when a portion of the rotator cuff tendon is torn but it does not extend all the way through the tendon, whereas a full tear extends from the top to the bottom of the tendon. The incidence of rotator cuff tears increases with age with full-thickness tears present in 25% of those in their 60s and more than 50% of those in their 80s. 

Common symptoms of rotator cuff injuries include:

• Pain and swelling in the front of the shoulder and down the outside of the arm

• Pain when raising or lowering the arm

• Popping or clicking sound when the arm is moved

• A feeling of heaviness and weakness in the arm

• Inability to lift the arm or move it due to limited range of motion

Physical Therapy for Rotator Cuff Tendinitis & Rotator Cuff Tears

Physical therapy is an effective treatment for rotator cuff tendinitis and the management of rotator cuff tears to address pain and restore range of motion, muscle strength, and coordination. Physical therapists help heal the intact portion of the torn rotator cuff tendon to help avoid surgery and address deficits in strength and function through targeted strengthening and stretching of the shoulder, back, and chest muscles.

Non-surgical management of rotator cuff tears with physical therapy is recommended unless the injury is severe or a full-thickness tear has occurred. Research has shown that patients who do physical therapy for a rotator cuff injury demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. If surgery is necessary, however, physical therapy is essential to regain full function of the shoulder.

Exercise rehabilitation is the cornerstone of physical therapy treatment for rotator cuff injuries. The aim of the therapist is to restore full pain-free range of motion, flexibility, muscle balance, and shoulder and scapular muscular control and stability for a successful return to daily activities.  

Physical therapy treatment for rotator cuff injuries can include:

• Pain management using ice, massage, moist heat, and TENs unit

• Patient education, such as activity modification to minimize stress on the rotator cuff and posture retraining

• Manual therapy soft tissue and joint mobilizations and gentle stretching to recover range of motion in the shoulder

• Range of motion exercises to help shoulders move properly

• Targeted strengthening exercises of the shoulder, upper trunk, and back to relieve stress on the rotator cuff and correct muscle weaknesses and imbalances

• Functional work and sport-specific training

 There are generally three phases of rotator cuff injury and post-surgery rehabilitation:

1. Acute Phase: During this phase, the therapist helps the patient manage pain and inflammation using ice and heat and works to gently restore range of motion with manual therapy and scapular mobilizations.

2. Recovery Phase: Once painless full range of motion is achieved, the therapist then moves on to improving strength, flexibility, and biomechanics. The therapist progresses resistance training as tolerated by the patient, utilizing isometric muscle strengthening to regain strength in the rotator cuff and scapular regions.

3. Functional Phase: The therapist then progresses the patient to sport and work-specific exercises, incorporating eccentric exercise and advanced strengthening of the scapular muscles. The therapist evaluates the patient thoroughly to ensure they can safely return to sport or work.

If you have experienced rotator cuff injury or are recuperating after rotator cuff surgery, come work with our physical therapists to regain function and strength in your shoulder and return to your sport and work safely!