How Long till My Rotator Cuff Pain Improves?
Prognosis and Outcomes in Physical Therapy
One of the key differences in our practice compared to a normal, insurance based physical therapy is how we schedule our sessions. We normally do a session once every week to two weeks. This developed as a result of our focus on home plan including trigger management. The second reason was how we started to use braces, tape, and training aids.
Prognosis with a Rotator Cuff Injury
In the first two parts of this series we looked at the background information about the structure and function of the rotator cuff, and the common types of Rotator Cuff injuries that lead to pain and how to figure out what it is. With this final article we would like to offer some perspective on how rotator cuff injuries typically resolve.
Rotator cuff injuries have a wide range of outcomes, but most can be treated successfully.
If we catch symptoms in the early stages of tendinitis, this is a quick fix which only takes 1-2 visits.
If symptoms have been allowed to progress, we may have to spend more time changing movement patterns and modifying daily activities to allow for healing. A mid-range prognosis is typically about 4 visits.
If symptoms have progressed to the point of partial or full thickness tearing of the rotator cuff, the prognosis is highly variable. The prognosis will depend on the extent of the tearing, a patient’s current and target activity level, the amount of pain they are experiencing, and whether or not there are any other accompanying injuries.
Anecdotally, we have seen patients diagnosed with full thickness tears of one or more rotator cuff muscles. Some of these patients still play golf or tennis, and have almost full range of motion in the affected shoulder. Their only complaint is pain or weakness in a specific position. This goes to show the variable nature of rotator cuff injuries.
Rotator Cuff Outcomes
We view all our outcomes using a three tiered system, or a three level prognosis (read about how this informs our practice). For rotator cuff injuries, this breaks down as follows:
It is an acute presentation of a minor/moderate severity rotator cuff injury: typically tendinitis or tendinosis (tendinitis resolves the quickest of all pathologies).
There are little to no contributing factors that need to be addressed.
Treatment within session reduces pain dramatically or entirely.
All triggers are identified at the first session and implemented into the home plan.
The patient successfully uses the home plan >90% of the time.
Symptoms resolve with 2-3 visits over 2-3 weeks.
The injury has been ongoing and has been allowed to progress over weeks, months, or even approaching a year.
There are more intense symptoms and a greater degree of limitation.
There are other contributing factors which will also take time to address.
Treatment within the first session decreases the primary pain generator, but subsequent sessions are needed for a higher dosage.
Most or all of the triggers are identified.
The patient successfully uses the home plan >75% of the time.
Symptoms resolve with 4-6 visits over 6-8 weeks.
The injury is chronic or recurrent in nature, lasting many months-years. There has been no successful strategy in place around symptoms.
Symptoms are intense and limit activity substantially.
There are multiple other chronic/recurrent contributing factors which take more time to address as well.
Treatment within the first session is helpful, but will require a much higher dosage to address primary and secondary pain generators.
There are a substantial number of triggers, some of which go unidentified initially.
Triggers either cannot or will not be reduced due to patient’s work/activity demands.
The patient uses the home successfully about 50% of the time.
Symptoms resolve with 8-10 visits over 3-4 months.
Conclusion: other considerations regarding shoulder pain
While this series of articles provides a comprehensive look at the rotator cuff from subjective complaints to outcomes, there are many other considerations which go into managing rotator cuff injuries.
If the initial diagnosis and treatment is off, or does not have the typical response, the clinician must work back through the exam and consider other differentials.
Oftentimes there is dysfunction along the kinetic chain, starting with the thoracic spine, ribs, and scapula which also needs to be addressed.
Instability is another common finding which contributes to rotator cuff injury and requires further modifications to the plan.
Managing rotator cuff injuries does not have to be a grueling process for the patient and clinician. With a clear plan in place, most cases tend to follow the best case scenario in the three level prognosis.