Nonoperative treatment: The role of rehabilitation

Abstract

Currently the nonoperative treatment in patients with the diagnosis of massive rotator cuff tears remains controversial; however, the physical therapy plays a major role in improving the functions of the shoulder. Exercises combined with injection therapy, pharmacological management, and modification of activities have been the most used. Several studies about rehabilitation management have reported improvement in range of motion, muscle strengthening, and pain reduction. Physical therapy treatment should be reserved for those patients who maintain a functional range of motion, as well as strength of periscapular muscles, and autonomy in daily life activities, and those patients without significant pain. Anterior Deltoid Reeducation (ADR) should be done to compensate the biomechanics alterations and to prevent superior humeral head migration and subacromial impingement. The remaining rotator cuff and ADR are essential for the adequate function of the shoulder; rehabilitation exercises must focus on improving strength and kinematics to decrease the pain and increase the ranges of motion. A strengthening program should focus on scapular stabilizers, as well as the latissimus dorsi, to decrease the scapular dyskinesia and avoid the superior migration of the humeral head. These stabilizers are an important factor to begin rehabilitation in the nonoperative treatment of massive rotator cuff tears. The addition of specific rehabilitation program gives better short and short-medium term results than conventional physiotherapy modalities. Patients' education and multimodal treatment focused on an individualized physical therapy could be the best choice for nonoperative treatment.