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      • Speed's Test
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        • Hyperabduction Test
        • Roos (EAST)
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      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
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      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
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      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
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      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
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      • Hop Test
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      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
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      • Pivot-Shift Test
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      • Thessaly Test
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      • Standing Wall Shrugs at 90 Degrees Flex
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      • Standing Repeated Shoulder Extension with Squat
      • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
      • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
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Picture

Partial Thickness Rotator Cuff Tears- Do They Heal or Progress to Full?

1/30/2015

7 Comments

 
As physical therapists, we see many patients with a referring diagnosis of partial rotator cuff tear. Almost every patient with this pathoanatomic diagnosis will ask you one of these questions: "Can I injure it the tear worse? Will the muscle tear fully or recover? Will I need surgery?" These questions have complex answers with a myriad number of factors determining each answer. Below is a paragraph taken from the Orthopedic Physical Therapy Secrets book that should help answer the question, "Do partial rotator cuff tears heal or progress?"   
"1)Ruptured fibers can no longer sustain a load; thus increased loads are placed on neighboring fibers, making them more susceptible to rupture.
2) Disruption of the tendon fibers also disrupts local blood supply within the tendon, thus inducing ischemia.
3) Disrupted tendon fibers are exposed to joint fluid, which has a lytic effect on tendons that impairs the healing process.
4) When tendons heal, the scar tissue that replaces the ruptured tendon fibers does not have the same tensile strength as the original tissue; thus it is a increased risk of failure.
5) Once a tear becomes full thickness, loads that normally are distributed through the entire intact tendon often are transmitted at the torn margins of the rotator cuff tendon. This process produces a "zipper effect" and extends or unzips the tendon from the tuberosity. "

From the information above, it is evident that in many instances, partial thickness rotator cuff tears progress to full thickness tears. The physiologic tissue structure following an injury has changed. The blood flow and tensile strength of that tissue has been permanently altered. It does appear that partial tears do progress. So where does this leave us?

Fortunately, the physical therapy paradigm is shifting from a pathoanatomic to a pathokinesiologic model. Despite having a partial rotator cuff tear, patients can respond positively with conservative management. By addressing capsular mobility deficits, scapulohumeral strength and flexibility problems, and the presenting movement dysfunction, surgery is not always indicated following a rotator cuff tear. The Secrets book also states that variable amounts (33-90%) of individuals demonstrate improvements in pain and overall function despite having a full thickness rotator cuff tear. 

Not all patients will succeed with conservative management, but address your primary impairments and movement dysfunction and you will be able to decrease the patient's pain and improve their function. 

-Jim Heafner PT, DPT, OCS
References: 
Placzek, Jeffrey D., and David A. Boyce. Orthopaedic Physical Therapy Secrets. St. Louis, MO: Mosby Elsevier, 2006. Print.
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7 Comments
Mike
2/1/2015 02:15:14 am

What exercises and manual would you stay away from that you think Would make the tear worse? What exercises and manual would you incorporate into the program? Thanks

Reply
JeromeFrenchPT
2/1/2015 04:21:12 pm

Agree we could have great outcomes with conservative treatment. But, as you said the tears will progress and surgery will have better outcomes if it's done with a smaller tear, so...i think it's depend on patient's age, physical activities, job etc...

Reply
Jim Heafner
2/1/2015 07:27:01 pm

Jerome- you are exactly right. It is such a Catch-22: do surgery now with a smaller tear OR try conservative management and hope the tear doesn't progress...tough situation.

Mike- I will try to write another post on exercises to perform. This is a topic of debate, but I think it would be beneficial to break it down.

Reply
Devley link
6/30/2016 11:55:12 am

I think when it is small tear so many people do not want the long recovery associated with surgery. With some they do not heal 100%. Using techniques to heal the injured area first is a good route but be aware that further injury can happen. Especially as the shoulder has such a wide range of motion. I really believe in optimizing circulation to the affected area to bring in as much nutrient rich blood flow to help heal the injured tissues. Use of the BFST wrap is ideal as it does not put further strain on the tissues. Acupuncture, cold and heat wraps and ultrasound all have their pros and cons as well.
http://kingbrand.com/BFST-Home.php?REF=34PV16

Reply
Devley link
6/30/2016 11:55:23 am

I think when it is small tear so many people do not want the long recovery associated with surgery. With some they do not heal 100%. Using techniques to heal the injured area first is a good route but be aware that further injury can happen. Especially as the shoulder has such a wide range of motion. I really believe in optimizing circulation to the affected area to bring in as much nutrient rich blood flow to help heal the injured tissues. Use of the BFST wrap is ideal as it does not put further strain on the tissues. Acupuncture, cold and heat wraps and ultrasound all have their pros and cons as well.
http://kingbrand.com/BFST-Home.php?REF=34PV16

Reply
Devley link
6/30/2016 11:55:39 am

I think when it is small tear so many people do not want the long recovery associated with surgery. With some they do not heal 100%. Using techniques to heal the injured area first is a good route but be aware that further injury can happen. Especially as the shoulder has such a wide range of motion. I really believe in optimizing circulation to the affected area to bring in as much nutrient rich blood flow to help heal the injured tissues. Use of the BFST wrap is ideal as it does not put further strain on the tissues. Acupuncture, cold and heat wraps and ultrasound all have their pros and cons as well.
kingbrand.com/BFST-Home.php?REF=34PV16

Reply
Devley link
6/30/2016 11:55:59 am

I think when it is small tear so many people do not want the long recovery associated with surgery. With some they do not heal 100%. Using techniques to heal the injured area first is a good route but be aware that further injury can happen. Especially as the shoulder has such a wide range of motion. I really believe in optimizing circulation to the affected area to bring in as much nutrient rich blood flow to help heal the injured tissues. Use of the BFST wrap is ideal as it does not put further strain on the tissues. Acupuncture, cold and heat wraps and ultrasound all have their pros and cons as well.
http://kingbrand.com/BFST-Home.php?REF=34PV16

Reply



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    • Cervical Spine >
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      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Let Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
  • Insider Access
  • HEP
    • Neck and Shoulder >
      • Supine Chin Tuck
      • Supine DNF with Towel Assist
      • Supine DNF
      • Standing Chin Tuck Against Wall
      • Standing Chin Tuck Against Wall with Scaption
      • Seated Cervical Retraction Repeated
      • Seated Cervical Retraction with Extension Repeated
      • Seated Cervical Retraction with Sidebend Repeated
      • Seated Cervical Retraction with Rotation Repeated
      • Standing Wall Shrugs at 90 Degrees Flex
      • Seated Thoracic Whips
      • Standing Ballistic Shoulder Extensions
      • Standing Repeated Shoulder Extension with Squat
      • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
      • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
      • Seated with Arms on Pillows Shrugs
      • Seated with Arms on Pillows Shrug with Scapular Retraction
      • Supine Shoulder IR with GH Centralization
      • Supine Shoulder ER with GH Centralization
      • Holding Dumbbell at 180 Degrees Flexion for Time
      • Cat Camel
      • Prone T's
      • Prone Y's
      • Quad Chin Tuck w/ Shoulder Flexion
    • Low Back >
      • Supine TA Isometric
      • Standing TA Isometric Agains Wall with Squat
      • Supine BKFO
      • Quad Rock Back
      • Standing Hip Hinge
      • Sit to Stand with Hip Hinge
      • Repeated Lumbar Sideglides
      • Repeated Standing Lumbar Extension
      • Repeated Standing Lumbar Flexion
      • Repeated Prone Press-Ups
      • Repeated Supine DKC
      • Slump Sciatic Nerve Glides
      • Birddog Progression
    • Hip and Knee >
      • Clamshells with Progressions
      • Fire Hydrants with Progressions
      • Donkey Kicks
      • Bridge Variations
      • Repeated Hip Flexion
      • Squats
      • Seated Repeated Knee Extensions
      • CKC Seated Repeated Knee Extensions
      • Heel Slides
      • CKC DF with Tibial IR
    • Foot and Ankle >
      • Calf Raises
      • Calf Raises with Soccer Ball Between Medial Malleoli
      • Towel Scrunches with Foot in PF
      • Toe Flexion Using T-Band with Foot in PF
      • PF with Toes Flexed Using T-Band
      • DF with Toes Flexed Using T-Band
      • Forefoot Adduction
      • Gastroc Stretch
      • Repeated PF
    • Examination Templates
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