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Best Rotator Cuff Injury Treatment in Delhi

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What is Rotator Cuff Injury ?

A rotator cuff injury refers to damage to one or more of the four muscles and their tendons that surround the shoulder joint. These muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) form a “cuff” around the head of the humerus (upper arm bone), helping to stabilize the shoulder and allow for a wide range of movements, particularly lifting and rotating the arm. Injuries can range from inflammation (tendinitis) to partial or complete tears of the tendons.

Causes of Rotator Cuff Injury

Rotator cuff injuries are typically caused by two main mechanisms:-

  • Acute Injury (Traumatic):
    • Falls: Falling on an outstretched arm or directly on the shoulder.
    • Heavy Lifting: Lifting something too heavy with a sudden, jerking motion.
    • Accidents: Direct blow to the shoulder or a sudden, unexpected force.
    • These often result in sudden, severe pain and weakness, more common in younger individuals.
  • Degenerative (Wear and Tear) / Chronic Overuse:
    • Repetitive Overhead Activities: Common in athletes (e.g., baseball pitchers, swimmers, tennis players, volleyball players) and occupations (e.g., painters, carpenters, mechanics) that involve frequent overhead arm movements. This causes microtrauma and progressive fraying of the tendons.
    • Age: As people age (typically over 40), the blood supply to the rotator cuff tendons decreases, impairing the body’s natural ability to repair damage. This makes tendons more susceptible to tears.
    • Bone Spurs (Osteophytes): Bony growths can form on the undersurface of the acromion (part of the shoulder blade). These spurs can impinge on (rub against) the rotator cuff tendons when the arm is lifted, causing irritation and eventually a tear (shoulder impingement syndrome).
    • Lack of Blood Supply: Reduced blood flow to the tendons as part of the aging process can hinder repair.
    • Poor Posture: Chronic poor posture can alter shoulder mechanics, leading to increased stress on the rotator cuff.
    • Smoking: A known risk factor that can impair healing.
    • Genetics: A family history of shoulder problems or rotator cuff injuries.
Symptoms of Rotator Cuff Injury
  • Pain:
    • Often a dull ache deep in the shoulder.
    • Worsens with overhead activities, reaching behind the back, or lifting the arm out to the side.
    • Night Pain: Commonly disturbs sleep, especially when lying on the affected shoulder.
    • Pain may radiate down the side of the arm, but usually stops before the elbow.
  • Weakness: Difficulty lifting the arm (especially overhead), raising the arm out to the side, or rotating the arm. This can lead to difficulty with daily tasks like combing hair, reaching for objects, or dressing.
  • Limited Range of Motion: Reduced ability to move the arm, particularly active movements. Passive range of motion may be relatively preserved, especially in tendinitis or smaller tears.
  • Grating, Clicking, or Popping Sensations: Sounds or sensations when moving the arm in certain positions.
  • Stiffness: The shoulder may feel stiff.
  • Tenderness: Localized tenderness when pressing on the affected area of the shoulder.
  • Muscle Atrophy: In chronic, long-standing tears, there may be visible wasting of the shoulder muscles, especially the supraspinatus.
Advanced Physiotherapy for Rotator Cuff Injury
  • Acute Pain and Inflammation Management:
    • Ice/Heat Therapy: To reduce pain and swelling.
    • Manual Therapy: Gentle joint mobilizations (e.g., glenohumeral, scapulothoracic) to reduce pain, improve joint play, and address stiffness without irritating the cuff. Soft tissue massage to reduce muscle guarding.
  • Restore Range of Motion (ROM):
    • Pendulum Exercises: Early, gentle, gravity-assisted exercises to maintain motion without active rotator cuff engagement.
    • Passive & Active-Assisted ROM: Using the unaffected arm, a stick, or a pulley system to gently move the affected arm through its pain-free range.
    • Stretching: Progressing to gentle stretches for the shoulder capsule (especially posterior capsule) and surrounding tight muscles (e.g., pectorals, latissimus dorsi) to restore full mobility.
  • Scapular (Shoulder Blade) Stabilization:
    • Importance: The scapula provides a stable base for rotator cuff function. Dysfunctional scapular movement (dyskinesis) can contribute to impingement and overload.
    • Exercises: Strengthening muscles that control the scapula (e.g., serratus anterior, rhomboids, lower trapezius) to ensure proper positioning and movement during arm activities. Examples include wall slides, scapular protraction/retraction, and “Y,””T,””W” exercises.
  • Graded Rotator Cuff Strengthening:
    • Progressive Loading: Starting with isometric exercises (muscle contraction without movement) in a pain-free range, progressing to concentric and eccentric exercises.
    • Strengthening: Specific exercises for each rotator cuff muscle (supraspinatus, infraspinatus, teres minor, subscapularis) using resistance bands, light weights, or bodyweight. Emphasis on controlled, pain-free movements.
    • Eccentric Training: Crucial for tendon health, focusing on the lengthening phase of muscle contraction (e.g., slowly lowering a weight after lifting it).
    • Closed Chain Exercises: Activities where the hand is fixed (e.g., wall push-ups, planks) to promote co-contraction and stability.
  • Neuromuscular Control & Proprioception:
    • Balance & Stability: Exercises to improve the shoulder’s awareness in space and its ability to react to unexpected movements. This involves using unstable surfaces (e.g., wobble boards, foam pads) or controlled perturbation exercises.
    • Rhythmic Stabilization: Partner exercises where resistance is applied in varying directions to challenge and improve dynamic stability.
  • Functional & Sport-Specific Rehabilitation:
    • Task-Specific Training: Gradually integrating exercises that mimic daily activities or work tasks (e.g., reaching, lifting, pushing, pulling) into the rehab program.
    • Sport-Specific Drills: For athletes, progressive drills that simulate movements from their sport (e.g., throwing mechanics for baseball, swimming strokes, serving in tennis), focusing on proper technique and controlled power generation.
    • Plyometrics: For appropriate athletes, advanced exercises involving explosive movements to improve power and reaction time, but introduced carefully in later stages.
  • Postural Correction & Ergonomics:
    • Postural Education: Addressing poor posture (e.g., rounded shoulders, forward head) that can contribute to shoulder impingement and pain.
    • Ergonomic Assessment: For work-related injuries, evaluating workstation setup and providing recommendations to minimize repetitive strain and awkward postures.

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