MANAGEMENT OF ROTATOR CUFF TENDINOPATHY INTRODUCTION. The rotator cuff are group of muscles and tendons that surround the shoulder joint, keeping the humerus bone firmly within the shallow socket of the scapular. A rotator cuff tendinopathy can cause a dull ache pain in the shoulder that worsens at night. Physiotherapists has a fundamental role in the management of rotator cuff pathology, whether the choice is conservative or surgical treatment, inform of exercises and use of therapeutic modalities. Exercise therapy program is tailored to each patient's capabilities at a given session the physiotherapist adjust exercise intensity as determined by the patient's ability.

2. INTRODUCTION
DEFINITION
MUSCLES TARGET
PATIENT EDUCATION
COMPLICATION
PHYSIOTHERAPY MANAGEMENT
ELECTROTHERAPY MODALITIES
EXERCISE PROGRAMES
PROGNOSIS
CONCLUSION
RECOMENDATION
REFRENCES

3.  The rotator cuff are group of muscles and tendons that
surround the shoulder joint, keeping the humerus bone firmly
within the shallow socket of the scapular. A rotator cuff
tendinopathy can cause a dull ache pain in the shoulder that
worsens at night.
 Physiotherapists has a fundamental role in the management
of rotator cuff pathology, whether the choice is conservative or
surgical treatment, inform of exercises and use of therapeutic
modalities.
 Exercise therapy program is tailored to each patient’s
capabilities at a given session the physiotherapist adjust exercise
intensity as determined by the patient’s ability.

4. DEFINITION
Rotator cuff tendinopathy is when a tendon
that attach the rotator cuff muscles to the bones
of the shoulder has tiny tears in it or is inflamed
and hurts. It’s usually caused by overuse or
general wear and tear.
(Tyler .2022)

5. MUSCLES TARGET

6. MUSCLES TARGET CONT…..

7. MUSCLES TARGET CONT…..

8. PATIENT EDUCATION
Care should be taken while
attempting movements with
weights
Avoid repeated compression
and nipping or pinching of
the tendon
Avoid sudden lifting of heavy
weight
Limit self from doing any
activities that increase pain at
shoulder region

9. COMPLICATIONS
 MUSCLES WASTING
 MUSCLES CONTRACTURE
 JOINT STIFFNESS AND LOSS OF RANGE OF
MOTION AT SHOULDER JOINT
 WEEKNESS OF MUSCLES

10. MUSCLES WASTING

11. PHYSIOTHERAPY MANAGEMENT
PAIN MANAGEMENT
1. CRYOTHERAPY
During the first few days of rotator cuff
tendenopathy, apply an ice pack to the shoulder for
15 to 20 minutes every four to six hours.
(Schmidt et al. 2015).

12. 2. TENS THERAPY
PHYSIOTHERAPY MANAGEMENT CONT……
Frequency 150Hz
Intensity patient tolerance
(‘X’W/cm2)
Duration 20mins
(J.Boundreault, J-S. Roy., et al. 2015)

13. PHYSIOTHERAPY MANAGEMENT CONT..
3. ULTRASOUND THERAPY
Frequency 1 Mhz
Intensity 1.5 to 2.0 W/cm2
Duration 5 t0 10mins
Desmeules,. 2015

14. EXERCISE
PROGRAME

15. PHASE ONE (weeks 0–3)
During this phase the physiotherapist helps the
patient manage pain and inflammation using
thermotherapy, and works to gently restore
range of motion with manual therapy and
scapular mobilizations and also stretching the
surrounding muscles.

16. CODMAN EXERCISE
Repetitions 2 sets of 10
Days per week 5 to 6
Equipment needed: None
To regain ROM at Glenuhemural joint.
Tip Do not round your back or lock your knees.

17. Repetitions 4 each side
Days per week 5 to 6
Main muscles worked: Posterior deltoid
patient should feel this stretch at the back
of his/her shoulder
Equipment needed: None
CROSSOVER ARM STRETCH

18. Repetitions 4 each side
Days per week 5 to 6
Main muscles worked:
Supraspinatus. patient should feel
this stretch at the front of his/her
shoulder.
Equipment needed: Light stick
Hold for 30 seconds and then
relax for 30 seconds
PASSIVE INTERNAL ROTATION

19. Repetitions 4 each side
Days per week 5 to 6
Main muscles worked:
Infraspinatus, teres minor. You
should feel this stretch in the
back of your shoulder
Equipment needed: Light stick
Hold for 30 seconds and then
relax for 30 seconds

20. Repetitions 4 reps, 3x a day
Days per week Daily
Main muscles worked:
Infraspinatus, teres minor.
Hold this position for 30 seconds,
then relax your arm for 30 seconds.
Tip Do not bend your wrist or press down on your
wrist
SLEEPER STRETCH

21. PHASE TWO (weeks 4–7)
Once painless full range of motion is achieved, the
physiotherapist then moves on to improving strength,
flexibility. The therapist progresses resistance training
as tolerated by the patient, utilizing isometric muscle
strengthening to regain strength in the rotator cuff and
scapular regions.

22. STANDING ROLL
Main muscles worked: Middle and lower trapezius.
Equipment needed: Use an elastic stretch band of
comfortable resistance.
Days per week 3
Repetitions 3 sets of 8
Tip: Squeeze your shoulder blades together as you pull

23. EXTERNAL ROTATION WITH ARM ABDUCTED 90°
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: Infraspinatus and teres minor .
Equipment needed: Use an elastic stretch band of
comfortable resistance.
Tip Make sure the patient elbow stays in line with his/her
shoulder.

24. INTERNAL ROTATION
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: Pectoralis, subscapularis
Equipment needed: Use an elastic stretch band of
comfortable resistance.
Tip patient is instructed to Keep his/her elbow pressed into
his/her side.

25. EXTERNAL ROTATION
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: Infraspinatus, teres
minor, posterior deltoid
Equipment needed: Use an elastic stretch
band of comfortable resistance. As the
exercise becomes easier to perform, progress
to 3 sets of 12 repetitions

26. PHASE THREE
(WEEK 7-10)
Early Strengthening – Rotator Cuff
Strengthening. The physiotherapist then
progresses the patient work-specific
exercises, incorporating eccentric exercise
and advanced strengthening of the scapular
muscles.

27. ELBOW FLEXION
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: Biceps, brachialis
Tip instruct the patient not to do this exercise too
quickly or swing his/her arm.

28. ELBOW EXTENSION
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: tricep
Tip Keep your abdominal muscles tight and do
not arch your back.

29. TRAPEZIUS STRENGTHENING
Repetitions 3 sets of 20
Days per week 3 to 5
Main muscles worked: Middle and posterior deltoid,
supraspinatus, middle trapezius.
Tip Use a weight that makes the last few repetitions
difficult, but pain-free.

30. SCAPULA SETTING
Repetitions 10
Days per week 3
Main muscles worked: Middle trapezius,
serratus
Tip Do not tense up in your neck

31. PHASE 4 (weeks 1O – 12+)
Advanced Strengthening the goals are:
increase strength, power and endurance, and un
restricted symptom – free activity

32. SCAPULAR
RETRACTION/PROTRACTION
Repetitions 2 sets of 10
Days per week 3
Main muscles worked: Middle trapezius,
serratus.
Tip Do not shrug your shoulder toward your
ear.

33. BENT-OVER HORIZONTAL
ABDUCTION
Repetitions 3 sets of 8
Days per week 3
Main muscles worked: Middle and
lower trapezius, Infraspinatus, teres
minor, posterior deltoid
Tip Control the movement as you lower
the weight.

34. INTERNAL AND EXTERNAL ROTATION
Repetitions 3 to 4 sets of 20
Days per week 3 to 5
Main muscles worked: Internal rotation: anterior deltoid,
pectoralis, subscapularis, latissimus External rotation:
posterior deltoid, infraspinatus, teres minor
Tip Use a weight that makes the last few repetitions difficult,
but pain-free.

35. EXTERNAL ROTATION
Repetitions 2 sets of 10
Days per week 3
Main muscles worked:
Infraspinatus, teres minor,
posterior deltoid.
Tip Do not let your body roll
back as you raise the
weight..

36. INTERNAL ROTATION
Repetitions 2 sets of 10
Days per week 3
Main muscles worked:
Subscapularis, teres
major.
Tip instruct the patient not
to let his/her body roll
back as he/she raise the
weight.

37. PROGNOSIS
In approximately 50% of people, it will resolve in
approximately 6 months through natural history
alone, meaning the body will heal itself. The other
50% go on to have rehabilitation, and positively, they
do well. Rehabilitation can take approximately 3-6
months to settle the pain.
Royal united hospital, united kingdom. 2021

38. CONCLUSSION
 Once the rehabilitation is completed it is
important to keep the shoulder muscles strong
to maintain fitness and to prevent injury. Most
people with Rotator Cuff Tendinopathy see
improvement after 6-12 weeks of rehabilitation
 Both clinicians and people suffering with the
symptoms of RC tendinopathy should derive
considerable confidence that the outcomes
achieved with an appropriately graduated
exercise programmed are equal to those
achieved with surgery for RC tendinopathy.
Educating the pat is an essential component of

39. RECOMENDATION
Physiotherapist should put more focus on hands on
rehabilitation techniques (Manual Therapy) to treat,
evaluate and improve the status of musculoskeletal
systems.

40. REFRENCE
 Itoi E, Tabata S. Incomplete rotator cuff tears: results of operative
treatment. Clin Orthop Relat Res. 1992;284:128-135.
 Royal united hospital, united kingdom. 2021
 Maffulli N, Longo UG. How do eccentric exercises work in
tendinopathy Rheumatology. 2008;47(10):1444-1445.
 Kurtais¸ GY, Ulus Y, Bilgiç A, Dinçer G, van der Heijden GJ. Adding
ultrasound in the management of soft tissue disorders in the
shoulder: a randomized placebo-controlled trial. Phys Ther.
2004;84(4):336-343
 Dean E, Söderlund A. Role of physiotherapy in lifestyle and health
promotion in musculoskeletal conditions. In: Jull G, Moore A, Falla D,
Lewis JS, McCarthy C, Sterling M. (eds.) Grieve’s Modern
Musculoskeletal Physiotherapy 4th ed. Elsevier, London In Press-b

41.  Sayampanathan, A. A., & Andrew, T. H. C. (2017). Systematic review on
risk factors of rotator cuff tears. Journal of Orthopaedic Surgery, 25(1),
2309499016684318..
 Leong, H. T., Fu, S. C., He, X., Oh, J. H., Yamamoto, N., & Yung, S. H. P.
(2019). Risk factors for rotator cuff tendinopathy: a systematic review
and meta-analysis. Journal of rehabilitation medicine, 51(9), 627-637

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