- Introduction
- When tendon inflammation or strain is present, non-surgical treatment is usually sufficient.
- Non surgical treatment does not mean that the shoulder injury is neglected, in fact, many patients who follow appropriate treatment and a rehabilitation program can have clinical success without surgery.
- Nonsurgical options help treat the injury and manage pain for minor sprains (clinically called type I and II Acromioclavicular joint injuries), stage 1 rotator cuff impingements, rotator cuff tears and shoulder arthritis.
- Treatment options differ according to location of injury, and the likelihood of successful treatment is affected by the size of rotator cuff tear and duration of presenting signs and symptoms.
- Non-surgical treatments can provide relief of symptoms of a rotator cuff tear in some, but not all, people. While different studies have found different rates of success, about 50% of people who try non-surgical treatments will find relief of symptoms.
- There is no set time frame for overcoming a shoulder impingement without surgery. It may take weeks of ice, anti-inflammatory drugs and exercise to overcome the inflammation and pain. Those who are more proactive in their treatment generally recover more quickly.
PHYSICAL THERAPY ( PHYSIOTHERAPY)
- Often prescribed with medication to alleviate shoulder pain.
- Begins with an assessment of patient's condition
- Helpful in preventing frozen shoulder due to pain, where the patient stops using the shoulder and the muscles seize up,compounding the problem.
- Most important step in treating rotator cuff injury by preventing stress on these muscles.
- This rehabilitation treatment focuses on 2 important aspects of shoulder motion- flexibility and strength.
- For example: Range Of Motion exercises (ROM)
- Pendulum exercises- bend over at the waist letting the affected arm hang down at your side, sway body back and forth using the weight of arm and gravity to form small circles at the surgical shoulder, then move arm counterclockwise and clockwise using this technique.
- Isometric exercises- these strengthen the shoulder muscles
- Stretching exercises- must not increase pain, edema and inflammation. It enables an increased range of motion without compromising ligaments and tendons
- Weight-bearing exercised may begin when full range of motion is attained.
- Personalized to fit each individual's
- cognitive and psychosocial motivation
- understanding of perception of pain
- goal-setting and limitations
- integrating patient back into productive work and social activity
REST AND REHABILITATION
- A person with rotator cuff injury should rest the shoulder and avoid positions/ activities that may strai the muscles.
- It is important not to immobilize the shoulder as it is possible to develop a frozen shoulder.
- At home, general care involves "R.I.C.E." (Rest, Ice, Compression and Elevation)
- Short-term bed rest reduce both inflammation and joint pain, useful when multiple joints are affected.
- Heat therapy
- Use before activities that irritate chronic injuries- strains
- Can be applied at home using heat packs (gel or wheat based), wrapped in a towel
- Applied to injury 15-20 minutes at a time
- Other techniques using warm, damp towels, warm baths and heat rubs can also be easily used at home
- These may not be as effective at warming deeper tissues.
- Other methods of applying heat (http://www.sportsinjuryclinic.net/cybertherapist/general/heat_therapy.php)
- Ultrasound Therapy- produced by mechanical vibration of metal treatment head to generate heat within tissue, may cause an increase in the extensibility of structures such as ligaments, tendons, scar tissue and fibrous joint capsules, reduce pain and muscle spasm.
- TENS- Transcutaneous Electrical Nerve Stimulation (This has been explained in a previous post)
- Interferential stimulation- Uses a medium-frequency of alternating currents to incite tissues of injured muscles and joints, reduces pain, decreases oedema, increasing blood circulation to promote healing in injured tissues.
- Magnetic Field Therapy- Using pulsed or static electromagnetic fields to produce analgesia. (For example, magnetic bracelets purchased from high-street pharmacies.)
- Cold therapy
- reduce pain by numbing nerves around the joints.
- Applied for acute injury (sprain) for no longer than 20 minutes at a time.
MASSAGE THERAPY
- Deep tissue massage is often used in the treatment of soft tissue injuries such as tendonitis.
- Massage therapy relieves pain and increases range of motion while it increases circulation and speeds healing.
- It reduces stress and the production of stress hormone that heighten the perception of pain and contribute to tight muscles (which may cause or increase pain).
- Massage therapy is contradicted if there is swelling of the joint.
PHARMACEUTICAL TREATMENT
- Can be obtained over the counter (Aspirin, Ibuproen, Motrin) or with a doctor's prescription (Cereblex, Relafen)
- NSAIDs (Non-Steroidal Anti Inflammatory Pain Medications) are most commonly prescribed medications
- NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical in your body's production of prostaglandins that cause swelling and pain in a condition such as arthritis or bursitis. Therefore by interfering with cyclooxygenase, you decrease the production of prostaglandins, and decrease pain and swelling associated with these conditions.
- Traditional NSAIDs (Ibuprofen, Motrin, Naproxen) block both COX 1 and COX-2 enzymes. There's a risk of getting stomach ulcers with these drugs because COX-1 (involved in producing the protective gut lining) is inhibited.
- Newer NSAIDs (Cereblex) work against COX-2 allowing COX-1 to function normally. Thus the side effects of stomach ulcers are reduced.
- Anti-inflammatory medications can be taken regularly for a short period of time, and then be used when symptoms of a rotator cuff tear flare-up.
ALTERNATIVE MEDICINE
- Is used in place of conventional medicine
- Cortisone Injections (A steroid with powerful anti-inflammatory properties) such as Cenestone, Kenalog
- Usually there is a limit of 3 injections a year because the overuse of cortisone weakens the tissue structure and may increase risk of tears.
- Side effects: 'cortisone flare' due to crystallization of injected cortisone, leads to brief pain much worse compared to prior injection. Other possible effects are whitening of the skin and infections.
- Joint supplements (Glucosamine and Chondroitin) used for arthritic joints
- The theory is that consuming these supplements may increase the rate of forming new cartilage. However it is not proven to increase the quantity of cartilage precursors in joints.
- Joint Fluid Supplements
- A fluid supplement that acts as a lubricant for the damaged joint.
- Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient.
- However, these injections do not cure the diseased joint and joint replacement may be needed as the joint worsens with time.
- One common supplement is Hyaluronic Acid injection, which can be effective between 5-13 weeks.
- Acupuncture
- Based on the theory of Chi that circulates throughout the body. The Chi is manipulated using needles placed at Meridian pathways to restore balance to the body.
- Does't repair the tear but it is very useful in treating the inflammation that occurs as a result as well as providing a degree of analgesic relief
- It facilitates the healing process by promoting circulation, relieving nearby muscle tension and interrupting nerve pain signals.
- Naprapathy
- A physical and visual inspection of the musculoskeletal system is made to determine any imbalances.
- When a vertebrae is misaligned, tissues and organs will malfunction throughout the body.
- Naprapaths (Doctors of naprapathy) treat patients with sciatica, tendonitis, sprains and strains.
- Homeopathy
- Many animal, plant, mineral and synthetic substances are used in the remedies.
- An example is Calcium Phosphate to treat rheumatic pains in the shoulder and arm, Iron Phosphate for tearing pain in right shoulder and arm and Ruta g. for wrenching pain in shoulder joint.
COMPLEMENTARY TREATMENTS
- Is used together with conventional medicine, usually to lessen a patient's discomfort following surgery.
- Reiki
- A japanese form of spiritual healing
- The practitioner places his hands in a series of positions over the patient's whole body, not just the affected area.
- A treatment will usually progress with the practitioner moving their hands from one specific position to another, and holding each position for between 3 and 5 minutes. Areas usually covered include the head, back, stomach, knees and feet. Between 12 and 20 positions are used and treatments therefore last for 45-90 minutes. Clients often report feelings of warmth and tingling on areas being treated, even when the hands are not in contact! - There is no scientific evidence available to support the effectiveness of Reiki and especially the presence of the life force energy described in Reiki teachings.
- Kinesiology tape
- There is a method of applying Kinesio tape correctly, and it stems from a holistic practice known as kinesiology.
- A trainer or a therapist certified in the use of Kinesiology tape to helps to apply the tape correctly to your shoulder area.
- Kinesio tape should be applied to your shoulder when your arm is extended fully at 90 degrees.
- Gently press the tape at the top of the shoulder area and unroll it down the length of your arm toward the e elbow. This ensures that the tape will glide along the same direction as your shoulder and arm muscles. Keep your arm extended when patting the Kinesio tape down.
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