General information
A rotator cuff tear can have many causes. In most cases, traumatic conditions in degeneratively pre-stressed muscles lead to severe pain and impaired movement in the area of the affected shoulder and arm after a tear or rupture. As a rule, the diagnosis of a rotator cuff tear must be followed by surgical therapy, which involves joining and suturing the torn muscle ends.
Today, the operation is usually performed arthroscopically, i.e. with two small skin incisions above the shoulder joint, and does not take long. Especially in the shoulder area, there is always a risk of permanent movement impairment or even stiffening in such diseases if the joint is immobilized too long before or after the operation. For this reason, special attention should be paid to consistent and regular follow-up treatment.
Follow-up treatment with medication
During the healing process, pain and discomfort can occur again and again, especially during movement. Since it happens that the patient goes into a relieving posture and does not perform the corresponding exercises consistently, adequate pain treatment must be ensured. Drug treatment is usually carried out with anti-inflammatory and pain-relieving medication.
Here, drugs such as ibuprofen 600 mg 3 times a day or 800 mg 3 times a day as well as diclofenac 75 mg in the morning and evening are used. In the case of more severe pain, treatment with Tramal 100 mg can also be attempted. In addition to drug pain treatment, it may also be useful to reduce the pain with cold. Here, ice packs should be placed on the affected shoulder and this should be repeated 2-3 times a day.
Physiotherapeutic aftercare
One of the most decisive follow-up treatments is the subsequent physiotherapy. It is intended to ensure that the rejoined muscles are fully functional again and can take over the corresponding tasks completely. Fresh traumatic rotator cuff ruptures must be immobilized for the first six weeks.
The immobilized ruptures should be practiced passively from day one, i.e. the patient should not make any active or stressful movements (no lifting of weights or similar). In physiotherapy, this is also referred to as blessing and swinging the arm out of the bandage. The therapist performs the movements on the patient’s arm himself, while the patient lets the arm muscles relax.
After the six weeks of the stress break, the arm may then be actively moved by the patient. While passive physiotherapeutic exercises are primarily intended to avoid stiffening of the joint, the subsequent active build-up is mainly aimed at exercising the muscles of the rotator cuff. This is particularly important because, on the one hand, the muscles are still irritated after the surgical procedure and, on the other hand, because the muscles have increasingly deteriorated after six weeks of relaxation and have become atrophic.
For this reason, special attention should be paid to the targeted reconstruction of the muscles. To do this, the so-called agonists, i.e. the muscles that perform the same movement as the muscles of the rotator cuff, are first trained to support the rotator cuff muscles. This is done by exercising with a light band.
The band should then be held so that it takes some effort for the muscles to move against the resistance. Where the muscle has to overcome an appropriate point of force to be stronger than the resistance, muscle building occurs. After the slight resistance of the band, light dumbbells of 1.5 kg are used first, followed by 3 kg later.
The higher the resistance the muscle creates, the more it is trained and the more it can support the muscles of the rotator cuff. Once the agonists have been trained accordingly, the so-called antagonists are used. These are muscles that perform the opposite movement in the body.
Only when both muscle groups have been trained equally and there is no imbalance can the usual movement be performed with the same strength and endurance. The so-called eccentric training then follows the dumbbell training. This involves more intensive stretching and support exercises.The most active period of movement should be from the 25th week after the operation; it can ultimately be carried out as long as there are still deficits in movement.
Tendonally, it is better to practice a little longer. The training should be daily shortly after the operation, but can then take place every second or third day. The physiotherapeutic aftercare is covered by the statutory health insurance.
