INTRODUCTION
Rotator Cuff Tendinopathy encompasses a broad spectrum of disorders, which involve the key soft tissue structures that help the shoulder achieve its complex biomechanical functions. It is a painful syndrome characterized by inflammation and chronic degeneration of the tendons, due to repeated mechanical compression against the bony outlet. Repetitive overuse of the shoulder such as frequent overhead activities causes inflammation of the rotator cuff (most commonly the supraspinatus) and inflammation of the sub acromial bursa. Attributed risk factors involve intrinsic mechanisms such as changes in vascularity, altered microarchitecture and physiological properties as well as extrinsic mechanisms such as a narrowed outlet, acromial morphology and abnormal
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X-rays are useful to identify a reduced supraspinatus outlet and any acromial dysmorphism. MRI is beneficial preoperatively in evaluating rotator cuff tears and atrophic changes. Once a diagnosis has been arrived upon, the available treatment options are vast and usually involve a conservative management in most cases, while surgical interventions are generally opted for the sporting subgroup or only if conservative measures fail to succeed. Conservative management often involves a progression from pain control to restoring flexibility and eventually a graded exercise regimen to restore rotator cuff control and shoulder kinematics for optimal use. Medical measures help to control acute symptoms by the use of NSAID’s, steroids and local anesthetics in some cases while physiotherapy is essential for proper muscle activation following the acute phase. Modalities such as Ultrasound, Cryotherapy and LASER promote healing; stretching programs prevent muscle inhibition and improve flexibility, while eccentric loading restores muscle strength and coordination to the normal. Addressing lifestyle modifications such as cigarette smoking, stress management and diet must also be emphasized in
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
Witvrouw, E., Mahieu, N., Roosen, P., & McNair, P. (2007). The role of stretching in tendon injuries. British journal of Sports Medicine , 224-226.
Therapeutic stretches of the gastrocnemius and soleus muscles. If the ligament are weakened, cross fiber friction them to try to regain some of the integrity of the ankle back.
When comparing rotator cuff tears from the common people and athletes, they are much more common when a person is physically active in sports. An injury in the rotator ...
The first non-operative treatment is physical therapy, which is the treatment of disease, injury, or deformity by physical methods. The methods include massages, heat treatments, and different exercises. The second non-operative treatment is ice and heat application. This method includes the use of ice and heat to stimulate blood flow and decrease swelling. The use of ice applied with compression and elevation treat patellar dislocation. (Arbuthnot, 1) In the same way, Heat is also used. Heating therapies are considered to be superficial or deep. Deep heating involves conversion of energy from one form to another within the tissues such as acoustic energy or diathermy. Superficial heating occurs by conduction such as hot pack, hot spa, and radiation. (Arbuthnot, 2) The third non-operative treatment is electrical stimulation. Electrical stimulation is a therapy that passes an electrical current to an affected area of the body. This type of stimulation alters muscle’s contractility which then increases blood flow to the tissues of the thigh. The picture below shows a patient who is receiving electrical stimulation. The fourth non-operative treatments are braces and patellar taping. Braces are used to restore proper alignment. Similarly, Patellar taping is used to provide stability for the knee. It seems to be a safe and effective way to treat patellar dislocation. (Aminaka,
Shoulder injuries are very common amongst people of all ages. If you think about it, we use our shoulders for numerous daily activities like driving, reaching up in cupboards, washing and brushing our hair, picking up items off the floor, reaching in our pockets whether it be in the front or the back, putting a belt on, and many others. A common injury that occurs in the shoulder though, is the rotator cuff. This structure is very often torn in individuals who use a lot of overhead reaching motions or are forcefully pulling objects constantly. A couple examples of people that do these motions constantly are athletes and construction workers. A rotator cuff tear can be caused by a direct-blow to the shoulder or it can happen over a period of time with wear and tear. Normally when an individual has a rotator cuff tear, they will present with pain or weakness when trying to lift their arm.
Graston instrument-assisted soft tissue mobilization (GITSM) is a tool used by therapist and chiropractors to help break up the scar tissue and replace it with fibroblast allowing for faster recoveries (Black 2010). A series of heat, GISTM, then strength and flexibility training are required (Black 2010). Numerous studies have been conducted, by certified therapist qualified in GISTM, to examine the styles and recovery periods after an injury. After going through the treatment, patients are measured by their range of motion (ROM) to see if the treatments were effective or not (Black 2010). ROM can vary depending on the region of the body that is being treated, but the overall goal of GISTM is to allow a person to get back to their regular routines they had before their injury. A study conducted by Logan College of Chiropractic shows that plantar fasciitis (foot) can be treated by GISTM on the first day of treatment (Daniels and Morrell 2012). Another study by Duke University shows that GISTM can be effective for patients after surgery that had an injury in the Patellar tendon (knee) (Black 2010). After several treatments, GISTM can, also, be used to treat a compression fracture in the lumbar (back) (Papa 2012). Each study shows the method of GISTM, the patient’s recovery period along with the methods of recovery.
Skeletal, smooth, and cardiac muscles play a vital role in the everyday processes that allow the human body to function. Without these muscles, everyday tasks and functions could not be conducted. Injury to these muscles could cause serious problems, however, these muscles have the ability to regenerate, repair, and fix multiple problems all by themselves. Repair and regeneration of a muscle are two similar, yet different things. Repair restores muscle continuity so that it can continue to function in the same way as before injury, but does not completely restore the pre-injury structure like regeneration (Huijbregts, 2001). Muscle repair and regeneration take place after an injury, after surgery, after atrophy, and even after working out.
One of the oldest ways to deal with a tendon injury is tendon splitting. Tendon splitting is when the vet inserts a scalpel or a knife into the lesion and cuts down the entire lesion (Sellnow, 2000). Using this type of therapy for tendon healing, allows the vet to let the tendon heal in a controlled environment as he is creating the injury. This healing method, also increases the blood supply while also decreasing the fluid that will have accumulated within the injury (Sellnow, 2000). One of the major problems with tendon splitting is that it can do more damage to the tendon than good, if the injury isn’t that severe and can heal on its own. When using this form of tendon healing the owner has to be aware of the high amount of Phenylbutazone that has to be used in order to...
The solution to this problem is located in the lab. Researchers across the country are working day in and day out to come up with a solution to accelerate the healing of soft tissues. They have come up with many solutions, from vibration therapy, to personalized rehab plans, but none of these are yielding truly significant results. I believe the solution lies at the molecular level. I believe that we can observe the healing of these soft connective tissues and learn from it. Then we can design a method from the observations to accelerate the production of the fibrils and collagen that will go on to make up the soft connective tissue. I have begun to take the beginning steps in solving this problem through my mentorship with Dr. Weinhold. Our research goals go hand in hand, which has led us to beginning research on the release of an angiogenic growth factor through a gelatin that will coat sutures. In theory, this angiogenic growth factor, once released from the crosslinking with the gelatin will stimulate the development of blood vessels around the recently repaired collagenous tissue. This, in turn, will allow the tendon/ligament to have a better oxygen supply and allow for quicker
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn
• Redness, swelling, or bruising in your shoulder. • Your shoulder feeling warm to the touch. • Your shoulder looking curved in (concave) or not feeling as firm as before. DIAGNOSIS This condition may be diagnosed based on a physical exam and medical history. You may also have imaging tests, such as an X-ray or MRI, to check for a fracture, dislocation, or rotator cuff injury in your shoulder.
Under a biopsychosocial plan of healthcare attention is given to many influences such as overuse, misuse or trauma (biomechanical), nutritional imbalance, inflammation or hormonal factors (biochemical) and stress, anxiety or depression (psychosocial) (NZ College of Massage, 2016). There is no suggestion that soft tissue therapy can treat the other influences mentioned, and where applicable, a referral to an appropriate healthcare provider will be arranged. Your therapist will work with other health practitioners which could include your specialist, physiotherapist, occupational therapist and/or your doctor which will help implement a treatment plan with the intention to improve or help manage your pain. You also have a major role to play as well and will be encouraged to actively become involved (as well as other family members if needed) to help with your individual care plan (Farin, Gramm & Schmidt, 2013). It is a team effort and it is important you are included
in soft tissue mobilization pressure.” Medicine and Science in Sports and Exercise. April 1999: 531-5.