Shoulder Function in Spite of Rotator Cuff Dysfunction

Tennis player with shoulder pain

If you read my previous post on rotator cuff pathologies, you know that a surprising amount of people can recover well from a rotator cuff injury without surgical intervention. A study by Tashjian (2012) provides insight into which patients are most likely to benefit from conservative management through physical therapy and which would be better served having early surgery. 

Key Aspects of Conservative Management 

For those who choose conservative management, physical therapy focuses on three main goals: 

  1. Pain Reduction: Alleviating discomfort to improve overall quality of life. 
  2. Restoring Range of Motion and Function: Enhancing the ability to perform daily activities without pain. 
  3. Rebuilding Strength and Stability: Improving muscle balance and control of both the shoulder joint and shoulder blade. 

Activity modification is another crucial component of conservative management. Avoiding movements or positions that exacerbate symptoms is essential in reducing symptoms and preventing further damage to the rotator cuff. 

How can recovery happen without repair? 

Tileshop

With the rotator cuff being such a vital piece of the shoulder, it is natural to question how the shoulder can function without it. 

A systematic review by Ainsworth and Lewis (2007) sheds light on how patients with full-thickness rotator cuff tears have made significant progress through physical therapy. Here’s how: 

  1. Pain Management Through Exercise: Exercise helps our bodies process pain differently. Physical activity sends signals to the brain that can reduce the perception of pain. 
  2. Muscular Compensation: Other muscles around the shoulder learn to compensate for the damaged rotator cuff. For example:
    • Deltoid: This muscle plays a greater role in shoulder abduction when the supraspinatus (a key rotator cuff muscle) is dysfunctional. 
    • Scapular Stabilizers: Muscles like the trapezius, rhomboids, and serratus anterior stabilize the shoulder blade and begin playing a larger role in reducing stress on the shoulder joint. 
    • Latissimus Dorsi and Teres Major: These muscles help counteract the deltoid’s anterior pull on the humerus, stabilizing the shoulder in the absence of a typically functioning rotator cuff. 
    • Teres Minor: The infraspinatus is a commonly torn rotator cuff muscle, the teres minor is less frequently torn and is able to continue externally rotating the shoulder in the absence of a properly functioning infraspinatus. 
  3. Reducing Fear of Movement: Teaching patients to progressively move their arm in a pain free range and engage in physical activity can alleviate fear and uncertainty, promoting recovery. 
  4. Mechanotherapy: Controlled loading of tendons through physical therapy is believed to stimulate repair and remodeling of tissues, including rotator cuff tendons. 

In summary, even without a fully intact rotator cuff, a combination of muscular compensation, strategic exercise, and activity modification can enable significant recovery. Through these mechanisms, patients can work with their physical therapist to optimize their rehabilitation and regain shoulder function.

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