this is the normal treament stuff i shall post up the surgical stuff later tonight or early morning
Self-Care at Home
- Rest the injured shoulder.
- Apply ice for 15-20-minute periods at least three times a day for the first two days after the injury. A helpful hint for applying ice to the shoulder would be to use a large Ace bandage to wrap over the top of the ice on the shoulder. The wrap can be taken around the injured arm and across the body.
- Apply heat after two days of applying ice. Warmth may be helpful. You can lay a heating pad over the shoulder while sitting up.
- Take an antiinflammatory medication such as ibuprofen or naproxen sodium to decrease the pain and swelling. Do not take if you have an allergy to it or certain other medical concerns, such as stomach or kidney problems
Chronic tear
- Pain control usually is the goal of treatment. This can be accomplished with rest and acetaminophen (Tylenol), aspirin, or ibuprofen.
- Occasionally, injections of steroids into the shoulder joint are helpful.
- Perform passive range-of-motion exercises (often best initially done with aphysical therapist).
- People with continued pain may require surgery and follow-up with an orthopedicsurgeon.
Acute tear
- Apply ice to decrease swelling. Wrap the ice in a cloth to avoid freezing the skin. Apply the wrapped ice 15-20 minutes at a time. This is most helpful in the first one to two days.
- Antiinflammatory medications may help reduce pain and swelling. Medicines such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) are examples available over the counter.
- Support the arm in a sling to rest the rotator cuff muscles. The sling may be taken off at night.
- The emergency physician may ask you to be seen for follow-up, either by a primary-care doctor or an orthopedic surgeon (specialist).
- Further imaging may be required to determine the degree and involvement of muscle tear. This is often done via magnetic resonance imaging.
- Early surgery (within three weeks) to repair the tendon is often needed, especially for younger, more active people.
- Indications for surgical treatment
- Usually for people younger than 60 years of age
- For complete tears
- An option after failure to improve after six weeks of proper treatment
- If the person has a job that requires constant shoulder use
Tendinitis
- Beginning care
- Apply ice packs for 20-minute periods several times a day.
- Rest the shoulder in a sling for a short period of time. Prolonged use of the sling can cause stiffness, weakness, and loss of motion of the shoulder joint.
- Take antiinflammatory medicines, such as ibuprofen or naproxen sodium.
- More severe cases
- Use the techniques described for beginning care.
- Injections of steroids may be given into the shoulder joint.
- As things improve (two to three days), discontinue the use of ice. Apply heat packs with massage.
- Perform Codman exercises. These are passive range-of-motion exercises (often initially done with a physical therapist). These exercises are done to increase slowly the amount of motion of the shoulder while putting a low amount of stress on the rotator cuff itself. The exercises are performed as the person leans toward the injured side with the arm hanging freely and slowly moving the arm in a circle. Initially, the circles are small. With improvement and decrease in pain, the circles enlarge.
- Also, holding a broomstick with both hands and moving them in a large arc while relaxing the affected shoulder can passively stretch the soft tissues. Later, active motion may be achieved by walking your fingers up a wall with the affected arm.
http://www.emedicinehealth.com/rotator_cuff_injury/page7_em.htm#Medical Treatment
How does physical therapy help rotator cuff tears?
The goal of physical therapy is to improve the function of the muscles that surround the shoulder. Most people, athletes and weight-lifters included, only strengthen a few of the large muscles around the shoulder. Physical therapy targets the smaller, but important muscles around the shoulder that are commonly neglected. By strengthening these muscles, therapy can help compensate for damaged tendons and improve the mechanics of the shoulder joint.
http://orthopedics.about.com/od/rotatorcuff/f/therapy.htm
How does the cortisone injection help?
Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.
http://orthopedics.about.com/cs/paindrugs/a/cortisone.htm
Therapeutic Injections
Therapeutic injections (lidocaine plus a corticosteroid) are useful both because they are therapeutic and also because they can help the physician differentiate impingement from other problems. Indications for therapeutic injections include the following:
· Rotator cuff impingement that does not improve with conservative treatment, including NSAIDs and physical therapy.
· Older patients with clearly operable lesions, such as subacromial spurs, who are not good surgical candidates. Frequently, older, poor surgical candidates can be helped with periodic injections.
· As a diagnostic technique. If a patient fails to improve following a subacromial space injection and has normal radiographs with an ambiguous physical examination, the rotator cuff may not be the problem. Thus, after the injection, repeat impingement testing will verify the diagnosis if the pain is ameliorated.12-14
· For temporary pain relief in a patient with an operable lesion.
http://www.aafp.org/afp/980215ap/fongemie.html
Extracorporeal shockwave lithotripsy (ESWT) is used to treat calcific tendonitis, where crystalline calcium phosphate is deposited in a tendon. This most commonly occurs in the shoulder joint, specifically in the supraspinatus tendon of the rotator cuff. When calcific tendonitis is symptomatic, it may present as chronic, relatively mild pain in the shoulder, with sporadic episodes of pain radiating down the arm or to the neck, with mechanical symptoms or with severe acute pain due to an inflammatory response.
http://www.nice.org.uk/nicemedia/pdf/ip/IPG021guidance.pdf
Phonophoresis is the use of ultrasound (US) to enhance the delivey of topically applied drugs. this also can be used instead of steroid injection. http://www.ptjournal.org/cgi/reprint/75/6/539.pdf
What is it iontoporesis?
Iontophoresis is an effective, method for delivering medication across the skin using electricity as a motive force. A direct current is applied to an electrode containing an ionized medication (meaning that it has an electric charge to it, either positive or negative) and utilizing the principle that “like repels like”, the electric current acts as a force to “push” the medication across the skin barrier to the affected area.
What medication is used?
In the physical therapy setting, we use dexamethasone during our iontophoresis treatments. This medication is a corticosteroid that has potent anti-inflammatory action. What conditions is it used for?
We typically use iontophoresis on localized, soft-tissue and other musculoskeletal inflammatory conditions. Some of the conditions we commonly treat with iontophoresis are tennis and golfer’s elbow, jumper’s knee, achilles tendonitis, rotator cuff injuries, plantar fasciitis, and even temporomandibularjoint (TMJ) dysfunction.
What are the advantages of iontophoresis versus an injection?
Iontophoresis is a safe alternative to the patient receiving a steroid injection. This method avoids the skin damage and risk of infection as well as the discomfort of delivering an anti-inflammatory medication by injection. Iontophoresis delivers a greater concentration of medication to a localized area as compared to oral medications. This helps avoid systemic side affects altogether by delivering a very low amount of medication to the internal systems.
How long does the treatment last?
The anti-inflammatory actions of dexamethasone typically last for approximately 48-72 hours.
Table 1. Phases of Shoulder Rehabilitation
Phase I
Rest from painful activity
Anti-inflammatory therapy
Passive range-of-motion and active-assisted range-of-motion
exercises
Joint mobilization
Strengthening (submaximal 3 maximal)
Scapulothoracic strengthening
Aerobic conditioning
Phase II
Progress range of motion and flexibility
Strengthening (submaximal 3 maximal)
manual, elastic band, and isotonic
multiangle isometrics
short-arc 3 full-arc excursion
Aggressive scapulothoracic strengthening and integration
Aerobic conditioning
Phase III
Prophylactic stretching
Strengthening and endurance (to full range and emphasize
eccentrics, then progress to sport-specific positions)
Variable or free weight resistance, or both
Bodyblade (Hymanson Inc, Playa Del Ray, CA)
isokinetics
plyometrics
Phase IV
Return to sport
http://www.nata.org/jat/readers/archives/jt0300/jt030000300p.pdf
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