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. 2016 Apr;11(2):279-301.

EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE

Peter Edwards  1 , Jay Ebert  1 , Brendan Joss  1 , Gev Bhabra  2 , Tim Ackland  1 , Allan Wang
Affiliations

EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE

Peter Edwards et al. Int J Sports Phys Ther. 2016 Apr.

Abstract

The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries.

Level of evidence: Level 5.

Keywords: Conservative management; exercise rehabilitation; physical therapy; rotator cuff tear.

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Figures

Figure 1.
Figure 1.
Treatment algorithm for pathology of the rotator cuff. Information derived from Tashjian et al
Figure 2.
Figure 2.
The pendulum exercise
Figure 3
Figure 3
A and 3B. Active-assisted external rotation using a bar powered by the non-affected arm to generate movement
Figure 4
Figure 4
A and 4B. Active-assisted supine elevation, using the the non-affected arm to generate movement
Figure 5.
Figure 5.
Cross-body stretch for the posterior capsule
Figure 6.
Figure 6.
Anterior capsule / pectoralis minor stretch using a door-frame
Figure 7.
Figure 7.
Low row exercise as described by Kibler et al99
Figure 8
Figure 8
A and 8B. Side-lying external rotation
Figure 9
Figure 9
A and 9B. Prone shoulder extension
Figure 10
Figure 10
A and 10B. Supine shoulder flexion
Figure 11
Figure 11
A and 11B. Incline shoulder flexion
Figure 12
Figure 12
A and 12B. Standing shoulder flexion
See this image and copyright information in PMC

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