if physical therapy isn't making any improvement on a rotator cuff problem, what is next?

Answer 1

It is standard to first try physical therapy for a rotator cuff problem without first having tests...as most will get better with conservative care. Failure to have less pain or strength with 6-8 weeks of therapy is indicative for ruling out a rotator cuff tear or bone spur that is impinging the rotator cuff.This would require an MRI for best assessment.

If there is a moderate to large/massive tear, you are probably looking at surgery. This is because tendons have a very poor blood supply and have a limited ability to heal on their own. Osteopathic, massage therapy and accupuncture may help with the pain (and some people do live relatively pain free with chronic tears), but it WILL NOT "heal" the tear...it is physically impossible. Now, can you live with a rotator cuff tear? Absolutely, but how well you can function will depend on the nature of your work, your age, your hobbies etc. For those with large/massive tears, 90% of those people will not regain overhead function without surgery...so, many people choose to never reach with that arm and decline surgery...especially if elderly and retired. Most younger people of working age with large tears opt for the surgery because overhead use of their arm is vital.

Other conservative options include a corizone injection...which may help you tolerate the exercises better.

It should also be noted that if subacromial bone spurring is present, that you may eventually wind up with a rotator cuff tear anyway since it gradually "saws" away at the cuff. Therefore, many will opt for a "subacromial decompression" which a little simpler procedure where the "spurs' are sawed off.

If you do follow up with the doctor, your next step is to probably have an MRI to rule out rotator cuff tear. If a large tear is found, sugery is recommened sooner than later before atrophy of the cuff occurs. If only a small to moderate tear is found...you may wind up continuing PT

Answer 2

What's next is to get a new therapist. There are many consecutive series clinical trials showing that physical therapy is indeed quite effective in treating rotator cuff tears.

Unfortunately, most PT's don't keep up on the latest research and are either doing the wrong exercises or the right ones wrong. A few examples. There is no need to do more than one set per a rotator cuff exercise. How many are you doing? Are you doing the empty can exercise where you are lifting your arms out to your sides with your thumbs down? What a good way to impinge inflammed rotator cuff tendons between the greater tubercle and the acromion process!

May I suggest skipping all the worthless stuff you may (or may not) be doing, such as e-stim, ice, or heat. Instead, all you really need are two good strengthening exercises and maybe a few stretches IF you have any tightnesses in your shoulder. Here's how one strengthening exercise goes for the supraspinatus muscle, the most frequently torn rotator cuff muscle: Lay on your right side. With the left arm straight and resting against your body, take a light dumbell (start with 2-3 pounds maybe) and raise it straight up to the ceiling, going no higher than 45 degrees. Work up to 20 repetitions, do only one set per workout, workout 2-3 times a week, with a day of rest in between workout sessions. Repeat for the other shoulder. When you can do 20 repetitions in good form, add a pound. In 4-6 weeks, you should have a very strong rotator cuff and I'll just bet your shoulder will be feeling better. You can find more good rotator cuff exercises like this one in the book "Treat Your Own Rotator Cuff." Good luck.

Answer 3

I had the same problem. I did physical therapy for about 6 weeks and it didn't help. The next step was an MRI to look at it and see what was wrong... its a lot better than physical therapy!! I don't know if you have ever had one. They aren't bad at all... here is some info on it...

MRI machines use magnetic waves to stimulate tissues. This is different than X-rays. MRI scans are painless and may or may not require injections of special dyes. The signals produced by the stimulated tissues are picked up a special scanner and sent to a computer to be interpreted. The computer assembles all of the signals into an image the shows the physician a cross section of your shoulder. MRI is capable of picking up soft tissues like ligaments. This capability is not possible with X-rays.

An MRI machine has a large hollow tube with a table that you will lie down on in its center. The typical time required to take a scan varies but should be between 10 to 45 minutes. During the scan time, the technician will instruct you to lie as still as possible.

Hope this helped!!! Good Luck!! Hope you can figure out what is wrong. Your doctor may do something else and not am MRI but.. that is pretty much the standard

Answer 4

Boy, if that isn't the $64,000 question!

Anytime someone tells you how perfectly we are made, point to their hips, knees, and shoulders, then laugh.

I got a lot of benefit on my rotator cuff by seriously building up my delts. But it took years, literally, and it still pops out once in a while.

Answer 5

Get a tube of asparcreme at the drug store. Rub it on the shoulder every morning and every night. This will help relieve the pain. A heating pad should help also. Icing it with a cold pack will also help.

Take Ibuprofen every four hours to help with the inflammation and swelling and tenderness. It helped my knees enormously. Put your arm in a sling to help rest the shoulder.

It will last quite a long time. Do not over work the shoulder, that is why it keeps hurting. Some injuries need a lot of rest and take a very long time to heal.

My Husband hit his wrist on a doorknob in Aug. 1997 and it took 2 years to heal and occasionally still bothers him.

Answer 6

Have you tried acupuncture, a osteopathic doctor, or a chiropractor?

If anyone says "surgery" leave immediately. . . a good osteopath is worth their weight in gold, immediately followed by a acupuncturist and then the chiropractor...

Ask your "older" friends for referrals...........

Answer 7

surgery