Therapy

Both conservative and surgical treatment measures can be pursued in the context of a rotator cuff rupture. As a rule, conservative therapy usually involves an incomplete rupture of the supraspinatus tendon. If a complete rupture is present, an individual decision is made.

As a rule, patients older than 65 years and with tolerable pain are also treated conservatively. Conservative therapy measures can include the following areas: In contrast to surgical therapy, conservative therapy does not allow torn tendon parts to “heal together”. One reason for this is that the torn parts of the tendon have contracted, which means that healing is no longer possible.

In spite of this fact, conservative measures can restore shoulder function to such an extent that normal “everyday use” can be guaranteed. If such a result does not appear after about three months, you should consider together with your treating physician whether conservative therapy still promises success or whether surgical measures should be taken. These measures are described below.

Protection, for example by immobilization using a thoracic abduction orthosis. This is an aid that keeps the arm away from the chest. After removal of the orthosis, it is mobilized by physiotherapy.
Administration of anti-inflammatory drugs (non-steroidal anti-inflammatory drugs – NSAIDs), such as diclofenac, ibuprofen, indometacin or new generation NSAIDs (Cox2 inhibitors), such as Celebrex®.
Cryotherapy (cold applications), especially after an accident.
Physiotherapeutic, painless movement exercises, including stretching and strengthening exercises to prevent joint stiffness.
Training of the remaining musculature
Infiltrations (syringe) under the acromion to reduce pain

Not every rotator cuff tear is automatically treated surgically. A good option is conservative treatment, in which physiotherapy and muscle strengthening play an important role. Exercises that are carried out should be discussed with the treating physician or physiotherapist, as the rotator cuff tear can be further aggravated by incorrect execution of the exercises.

A first important group of exercises for rotator cuff tears are stretching and loosening exercises. The aim is to relax the surrounding joints and muscles and make them suitable for everyday use. For loosening the shoulder, circling the arms is a good way to do this.

This should be done carefully and evenly and jerky movements should be avoided. For stretching it is important to include the chest and back. To stretch the chest it is advisable to stretch the arms horizontally and hold them stretched sideways while standing.

Now both arms in stretched position try to move as far as possible towards the back and then hold for 30 – 60 seconds. You should feel a pull in the chest. For the upper back and the back shoulder the following is recommended: Put one arm around the neck from the front and place the hand on the back shoulder.

With the other hand, press carefully against the elbow so that the arm continues towards the back. Further stretching exercises can be shown by a physiotherapist. The next important step is to strengthen the muscles.

Since the torn parts of the rotator cuff usually do not grow together again, other muscles must compensate for their task as much as possible and this must be learned. Most of the exercises can be done in physiotherapy on the cable pulley or simply at home with the Theraband. Therabands can be purchased for less than 20€.

It is important to train the inner and outer rotation. The Theraband is put around a door handle so that you can hold both ends in your hand. To train the outer rotation, stand with the other shoulder to the side of the door handle.

Now hold both ends of the Theraband with your hand, the shoulder to be trained. The elbow is placed on the side of the body and bent by 90° so that the forearm points horizontally forward. Now pull the Theraband outwards and backwards with your hand, thereby extending the Theraband.

It is important that the elbow remains on the body. This can be done in three passes with 15-20 repetitions. For the other arm it is done in the same way, only you have to turn around.

To train the inner rotation, stand to the side of the door handle again. This time you stand with the shoulder to be trained towards the door and hold the Theraband with your hand, the shoulder to be trained. Again, the elbow is bent 90° and stays on the body.

This time, the forearm is rotated towards the abdomen, as if you wanted to grab the abdomen. There are three passes with 15 – 20 repetitions each. In order to train the other shoulder, you have to turn around accordingly.

An additional good exercise that trains the outer rotation and shoulder lift is as follows. The Theraband is held with stretched and applied arm at the hip of the opposite side. With the side to be trained the tensed Theraband is held at the end and pulled evenly upwards and outwards with stretched arm.

Thereby the arm makes a slight curve. Then the arm is moved back slowly and evenly. This exercise can be done for each arm in three passes with 10 – 15 repetitions each.

It is important that you do not continue with this exercise in case of pain, but first consult your doctor or physiotherapist. A fourth helpful exercise to strengthen the shoulder muscles is to keep the arms horizontal and stretched out in front of the body, approximately shoulder width. With both hands the Theraband is held taut.

Now both arms are stretched evenly and pulled backwards so that you have the feeling that the shoulder blades are touching each other. This exercise can be performed in three passes with 10-15 repetitions each. Another group of exercises that strengthens the muscles are the support exercises.

Here, you can lie down in the forearm support.Lie down on your belly, then place your forearms lengthwise underneath you on the floor and lift your belly, buttocks and knees so that you only touch the floor with your forearms and toes. Try to keep this position as long as possible. You can also do something similar in the push-up position.

Here you push yourself off the floor with your hands a little wider than shoulder width and try to hold this position. In both exercises the body tension must be maintained by tensing the abdomen, back and bottom. All exercises should be discussed with the doctor or physiotherapist in charge of the patient, as each patient may have individual complicating factors.

Tapering the shoulder in the case of a rotator cuff tear can be helpful and alleviate discomfort. The aim is to transfer the load that the affected tendon would otherwise have to bear. Furthermore, circulation is to be improved and pain reduced.

The tapes can be glued in different ways. There are different methods and views behind this. But the basic method is the same as the one used for taping the shoulder impingement.

Indication criteria with regard to the surgical treatment of a rotator cuff rupture are, for example Surgical therapy differentiates between the incomplete and the complete rupture with regard to the surgical procedure. Whether arthroscopic or open surgery is used depends on the size of the rupture. The smaller the rupture, the better it can be treated within the scope of arthroscopic surgery of the shoulder joint.

Larger tears can usually only be cleaned arthroscopically and the pain can be relieved by endoscopic subacromial decompression (ESD). Various procedures are available, such as acromioplasty according to Neer or excision of the tendon area. Suturing the supraspinatus tendon is also conceivable, for example in the event of a transverse tear in the rotator cuff.

In this case, one speaks of a so-called transosseous suture, i.e. a suture that is to be sutured through the bone at the place where it originally tore. There are various options for anchoring this procedure:

Severe pain
Age (< 65 years) in combination with professional and/or sports activities
Rupture of the rotator cuff on the dominant arm, usually the right arm
Resistance to therapy or degenerative changes in the shoulder joint due to wear and tear.
Screw anchors made either of titanium or of bioresorbable (= self-dissolving) material. All procedures require postoperative treatment.
Transosseous sutures, i.e.
the thread is pulled through the bone, which are sewn using a special suture and knotting technique (e.g. Mason – Ellen technique).

Post-treatment of rotator cuff tears is highly dependent on the patient, the type of treatment and the size of the tear. If it is a small tear that does not require surgery, physiotherapy is usually followed. In addition to muscle building with the above-mentioned exercises, the first priority is to heal the tear.

In the first weeks, it is advisable to take it easy. In addition, cold applications, acupuncture and also pain injections into the tendon area are helpful. However, this is especially useful in the first few weeks to reduce the pain of the accident or the inflammation.

In the case of fresh ruptures, only passive movement is allowed for the first 6 weeks. In the case of larger ruptures and during operations, the surgeon draws up a follow-up treatment plan which is passed on to the physiotherapist. After an operation, it is assumed that the tendon suture is only stable again after approx.

6 weeks. For this time, the arm must usually be held in a kind of abduction bandage. Exactly how long this bandage must be worn depends on the condition of the tendon and how well it heals.

During the first 4 weeks, the arm may only be moved passively and only in limited angular degrees. From the 4th week onwards, movement may be mostly assistive (supported by the therapist) and from the 6th week onwards, cautious active movement is allowed. Movements against resistance should be made from week 7 at the earliest. Exercises with weight should not be performed during the first 2 months.