Rotator Cuff Injuries and Interventions: A Physical Therapy Perspective

Shoulder pain is a common complaint in the general population (Cadogan, Laslett, Hing, McNair, & Coates, 2011; Lewis, 2016; Pribicevic, 2012; Teunis, Lubberts, Reilly, & Ring, 2014), and is generally experienced when lifting or moving the arm. It occurs most often in individuals involved in repetitive overhead activities or manual labor involving the arms. Disorders of the rotator cuff are the most common source of shoulder pain reported in primary care (Cadogan et al., 2011). Rotator cuff-related pain can be the result of subacromial impingement, tendonosis, or partial- and/or full-thickness tears of the rotator cuff tendons (Lewis, 2016). Age seems to be a strong predictor for tendon pathology, with risk of degenerative tearing increasing with each decade (Fehringer, Sun, VanOeveren, Keller, & Matsen, 2008; Teunis et al., 2014). In the presence of rotator cuff-related shoulder pain, current evidence seems to be equivocal for long-term outcomes and quality of life measures between surgical intervention and physical therapy, if the pain is associated with a small tear (Moosmayer et al., 2014). This suggests that early diagnosis and treatment can be important to identify potential causes, modify aggravating factors, and educate patients to prevent further injury (Goldberg, Nowinski, & Matsen, 2001; Harris, Pedroza, & Jones, 2012; Itoh et al., 2014; Kukkonen et al., 2014; Lewis, 2016). In the presence of small tears, recent evidence has shown that physical therapy (PT) may be as effective as surgery in long-term outcomes for rotator cuff-related pain; however, tear size may progress when treated conservatively (Kukkonen et al., 2014; Moosmayer et al., 2014). These important findings, combined with the high prevalence of these disorders, make it essential that physical therapists have a solid understanding of evidence-based examination and treatment of the rotator cuff to help individuals regain function.