Treatment of rotator cuff injuries

Treatment
Acute PhaseRehabilitation ProgramPhysical TherapyPain relief, which is the first goal of treatment, involves resting the shoulder. In most cases, the athlete should stop or significantly decrease his or her swimming activities. A physical therapist can help modify shoulder and activities to help avoid re-aggravation of the rotator cuff. Anti-inflammatory treatment in the form of regular icing and nonsteroidal anti-inflammatory medications should also be instituted until the athlete is pain free. Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, as directed for pain relief.The second goal of treatment is to restore normal strength in the rotator cuff. Regaining strength can be accomplished with a supervised exercise program for the rotator cuff using relatively light weights (2-3 lb, up to a maximum of 5 lb) and high repetitions (12-20 reps per set). These exercises can be performed on a daily basis or every other day.Working with a physical therapist (PT) can be helpful, particularly one with expertise in treating shoulder injuries and swimmers, who can help the athlete transition from dry land exercises to swimming. The addition of therapist-administered therapeutic modalities, such as ultrasound, phonophoresis, iontophoresis, or electrical stimulation can help further reduce pain and inflammation during the acute phase of injury.
Avoid tobacco smoke. Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking delays wound and tissue healing.Surgical InterventionSurgical intervention is considered in athletes who continue to have shoulder pain after a minimum of 6 months of guided rest and rehabilitation.The procedure should include an examination under anesthesia to determine the degree of laxity, a diagnostic arthroscopy (to look for labral or rotator cuff tears and capsular laxity), and, when indicated, a surgical tightening of the lax capsule (capsulorrhaphy). In the older athlete, a subacromial decompression is typically performed if there is arthroscopic evidence of impingement.The athlete should be cautioned about the postsurgical trade-off of increased shoulder stability for some loss of flexibility, resulting in difficulty in returning to swimming at the same level as before the injury.
Types of surgery:
· Subacromial Smoothing (Decompression)
In this procedure, the orthopedic surgeon removes inflamed tissue and bone spurs from the area around the rotator cuff. The procedure is performed on an outpatient basis, the healing time is shorter than traditional surgery, and the patient experiences less pain.
· Rotator Cuff Repair
In this procedure, the torn tendon is reattached to the arm bone. This procedure can be done using open (traditional surgery) or arthroscopic surgery. In either procedure, the surgery may be done on an outpatient basis. This allows patients to return home the day of the surgery, usually with little discomfort.
· Tissue Transfers
In some cases, rotator cuff tears are too large to be repaired. So, the surgeons transfer other tissue (soft tissue flaps, muscle tissue) to substitute for the damaged rotator cuff.
· Arthroplasty
Some rotator cuff tears may lead to development of rotator cuff arthropathy, which also includes arthritis. In such cases, extensive surgical options could be partial shoulder replacement(hemiarthroplasty) or total shoulder replacement(prosthetic arthroplasty).
Other available treatment involve the use of a reverse ball-and-socket prosthesis. This is most suitable for people with arthritis, extensive tears of multiple muscles and tendons that support the shoulder, or failed previous shoulder replacement.ConsultationsIn cases unresponsive to rest and rehabilitation, consultation with an orthopedic surgeon is recommended.Other TreatmentA corticosteroid injection may be considered in older patients but is rarely used in the adolescents and almost never in skeletally-immature patients.Recovery PhaseRehabilitation ProgramPhysical TherapyA capsulorrhaphy usually requires immobilization in an arm sling or immobilizer for 4-6 weeks to allow the capsule to heal in the surgically-tightened position. This is then followed by a rotator cuff strengthening program in physical therapy. Passive range of motion (PROM) is typically restricted during this time so as not to stretch out the capsule. ROM commonly returns on its own with exercise and normal shoulder use. One can expect about 50-75% of the normal shoulder motion to return by 3 months and 100% of motion by 6 months following successful surgery. Modified stroke work can begin once the athlete achieved a minimum of 80% of normal motion and strength in the shoulder. Return to competitive swimming is anticipated between 6 and 12 months following surgery.
Maintenance PhaseRehabilitation ProgramPhysical TherapyThe maintenance phase is the final phase of rehabilitation. The athlete should be independent with a strengthening program as instructed by his or her athletic trainer or physical therapist. The therapist and coach should both be involved in re-assessment of swimming mechanics and stroke technique, addressing any errors to prevent recurrence of injury.

Complementary treatment
Osteopathy
An approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. It is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Osteopathic principles teach that treatment of the musculoskeletal system (bones, muscles and joints) facilitates the recuperative powers of the body. It employs manual therapies for the treatment of many neuromusculoskeletal pain syndromes.
Chiropractic
A 100-year-old practice that uses noninvasive means to restore and improve health. Its tools include manipulation of the joints and surrounding tissue -- including muscles, tendons, and nerves -- to treat neck and back pain, joint pain, headache, muscle aches, and other health problems.
Although it's a widely used complementary treatment for pain, there's no medical consensus on its value. While some studies have found that spinal manipulation can relieve low-back pain, many other studies have found no such benefits. Most studies have focused on back pain, and the overall results are not that impressive. Most studies have focused on back pain, and the overall results are not that impressive. A survey of scientific studies published between 1996 and 2003 led the National Center for Complementary and Alternative Medicine to this conclusion: "Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain."
Massage
An "alternative" therapy that is quickly going mainstream. As reported in the journal Rheumatology, 71 percent of doctors say they have referred patients to massage therapists. A good massage can increase blood flow and warm muscles, and, yes, ease pain, especially back pain and arthritis.
Massage is generally very safe, but it should be avoided by anyone with bleeding disorders, people taking blood thinning medication like warfarin, anyone with low blood platelet counts, people with blood clots, fractures, open or healing wounds, skin infections, weakened bones (from osteoporosis or cancer), or someone who has had a recent surgery
Researchers believe that massage works in at least three ways. For starters, all that kneading and stroking allows your muscles to relax, which sends a message to your brain to produce fewer stress hormones; it also improves blood flow to the brain. The combination, studies show, results in a feeling of relaxed alertness. Massage may ease chronic pain as well, perhaps, researchers speculate, by triggering the release of enkephalins, the body's natural painkillers.
Biofeedback
This technique helps patients reduce their pain by giving them more control over their own bodies. Biofeedback users learn how to harness brainpower to increase their circulation or relax their muscles.
Acupuncture
A 5,000-year-old practice that originated in China, acupuncture involves stimulating certain points of the body with hair-thin needles to promote healing. The Chinese believe that good health depends on the proper flow of a vital energy called qi (chee) that moves through our bodies along invisible meridians, or pathways. Inserting needles into particular points along these meridians, they say, can tweak this life force into proper balance.