Editing Rotator cuff (section)

== Pain management ==
Treatment for a rotator cuff tear can include rest, ice, physical therapy, and/or surgery.<ref>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/treatment/txc-20128411|title=Rotator cuff injury - Treatment|work=Mayo Clinic|access-date=2017-09-10|archive-date=19 September 2017|archive-url=https://web.archive.org/web/20170919015612/http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/treatment/txc-20128411|url-status=live}}</ref> A review of manual therapy and exercise treatments found inconclusive evidence as to whether these treatments were any better than placebo, however "High quality evidence from one <abbr>trial</abbr> suggested that manual <abbr>therapy</abbr> and exercise improved function only slightly more than <abbr>placebo</abbr> at 22 weeks, was little or no different to <abbr>placebo</abbr> in terms of other patient-important outcomes (e.g. overall pain), and was associated with relatively more frequent but mild adverse events."<ref>{{Cite journal | title = Manual therapy and exercise for rotator cuff disease {{!}} Cochrane | url = http://www.cochrane.org/CD012224/MUSKEL_manual-therapy-and-exercise-rotator-cuff-disease | doi = 10.1002/14651858.CD012224 | pmid = 27283590 | year = 2016 | journal = Cochrane Database of Systematic Reviews | issue = 6 | pages = CD012224 | last1 = Page | first1 = Matthew J | last2 = Green | first2 = Sally | last3 = McBain | first3 = Brodwen | last4 = Surace | first4 = Stephen J | last5 = Deitch | first5 = Jessica | last6 = Lyttle | first6 = Nicolette | last7 = Mrocki | first7 = Marshall A | author-link8 = Rachelle Buchbinder | last8 = Buchbinder | first8 = Rachelle | volume = 2016 | pmc = 8570640 | access-date = 10 September 2017 | archive-date = 10 September 2017 | archive-url = https://web.archive.org/web/20170910220459/http://www.cochrane.org/CD012224/MUSKEL_manual-therapy-and-exercise-rotator-cuff-disease | url-status = live }}</ref>

The rotator cuff includes muscles such as the supraspinatus muscle, the [[infraspinatus]] muscle, the [[teres minor muscle]] and the [[subscapularis muscle]]. The upper arm consists of the [[deltoids]], [[biceps]], as well as the [[triceps]]. Steps must be taken and precautions need to be made in order for the rotator cuffs to heal properly following surgery while still maintaining function to prevent any deteriorating effects on the muscles. In the immediate postoperative period (within one week following surgery), pain can be treated with a standard ice wrap. There are also commercial devices available which not only cool the shoulder but also exert pressure on the shoulder ("compressive cryotherapy"). However, one study has shown no significant difference in postoperative pain when comparing these devices to a standard ice wrap.<ref>{{cite journal|last1=Kraeutler|first1=MJ|last2=Reynolds|first2=KA|last3=Long|first3=C|last4=McCarty|first4=EC|title=Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression|journal=Journal of Shoulder and Elbow Surgery|date=Jun 2015|volume=24|issue=6|pages=854–859|pmid=25825138|doi=10.1016/j.jse.2015.02.004}}</ref>

=== Continuous passive motion ===
[[Physiotherapy]] can help manage the pain, but utilizing a program that involves continuous passive motion will reduce the pain even further. [[Continuous passive motion|Assisted passive motion]] at a low intensity allows the tissues to be stretched slightly without damaging them<ref name="Plessis, M 2011">Plessis, M. Du, E. Eksteen, A. Jenneker, E. Kriel, C. Mentoor, T. Stucky, D. Van Staden, and L. Morris. "The Effectiveness of Continuous Passive Motion on Range of Motion, Pain and Muscle Strength following Rotator Cuff Repair: A Systematic Review." Clinical Rehabilitation (2011): 291-302</ref> [[Continuous passive motion]] improves the shoulder range and enables the subject to expand their range of motion without experiencing additional pain. Easing into the motions will allow the person to continue working those muscles to keep them from undergoing atrophy, while also still maintaining that minimum level of function where daily function is allowed. Doing these exercises will also prevent tears in the muscles that will impair daily function further.<ref name="Plessis, M 2011"/>

=== Manual therapy ===
A systematic review and [[meta-analysis]] study shows [[manual therapy]] may help to reduce pain for patient with Rotator cuff [[Tendinopathy|tendiopathy]], based on low- to moderate-quality evidence. However, there is not strong evidence for improving function also.<ref>{{Cite journal|last1=Desjardins-Charbonneau|first1=Ariel|last2=Roy|first2=Jean-Sébastien|last3=Dionne|first3=Clermont E.|last4=Frémont|first4=Pierre|last5=MacDermid|first5=Joy C.|last6=Desmeules|first6=François|date=May 2015|title=The Efficacy of Manual Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta-analysis|journal=Journal of Orthopaedic & Sports Physical Therapy|volume=45|issue=5|pages=330–350|doi=10.2519/jospt.2015.5455|pmid=25808530|issn=0190-6011|doi-access=free}}</ref>

=== Surgery ===
Surgical approaches include [[acromioplasty]] (a part of the bone is removed to decrease pressure placed on the rotator cuff tendons), removal of a bursa that is inflamed or swollen, and [[subacromial decompression]] (the removal of tissue or bone that is damaged in order to allow more space for the tendons).<ref name=":0">{{Cite journal|last1=Karjalainen|first1=Teemu V.|last2=Jain|first2=Nitin B.|last3=Page|first3=Cristina M.|last4=Lähdeoja|first4=Tuomas A.|last5=Johnston|first5=Renea V.|last6=Salamh|first6=Paul|last7=Kavaja|first7=Lauri|last8=Ardern|first8=Clare L.|last9=Agarwal|first9=Arnav|last10=Vandvik|first10=Per O.|last11=Buchbinder|first11=Rachelle|year=2019|title=Subacromial decompression surgery for rotator cuff disease|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD005619|doi=10.1002/14651858.CD005619.pub3|issn=1469-493X|pmc=6357907|pmid=30707445}}</ref>

Surgery may be recommended for patients with an acute, traumatic rotator cuff tear resulting in substantial weakness.{{Citation needed|date=April 2020}} Surgery can be performed open or arthroscopically, although the arthroscopic approach has become much more popular.<ref name=":0" /> If a surgical option is selected, the rehabilitation of the rotator cuff is necessary in order to regain maximum strength and range of motion within the shoulder joint.<ref name="Brewster93">{{cite journal |vauthors=Brewster C, Schwab DR |title=Rehabilitation of the shoulder following rotator cuff injury or surgery |journal=J Orthop Sports Phys Ther |volume=18 |issue=2 |pages=422–6 |year=1993 |pmid=8364597 |doi=10.2519/jospt.1993.18.2.422 }}</ref> [[Physical therapy]] progresses through four stages, increasing movement throughout each phase. The tempo and intensity of the stages are solely reliant on the extent of the injury and the patient's activity necessities.<ref>{{cite journal |author=Kuhn JE |title=Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol |journal=J Shoulder Elbow Surg |volume=18 |issue=1 |pages=138–60 |year=2009 |pmid=18835532 |doi=10.1016/j.jse.2008.06.004 }}</ref> The first stage requires [[immobilization (pathology)|immobilization]] of the [[shoulder joint]]. The shoulder that is injured is placed in a sling and shoulder flexion or abduction of the arm is avoided for 4 to 6 weeks after surgery (Brewster, 1993). Avoiding movement of the shoulder joint allows the torn tendon to fully heal.<ref name="Brewster93" /> Once the [[tendon]] is entirely recovered, passive exercises can be implemented. Passive exercises of the shoulder are movements in which a physical therapist maintains the arm in a particular position, manipulating the rotator cuff without any effort by the patient.<ref name="Waltrip03">{{cite journal |vauthors=Waltrip RL, Zheng N, Dugas JR, Andrews JR |title=Rotator cuff repair. A biomechanical comparison of three techniques |journal=Am J Sports Med |volume=31 |issue=4 |pages=493–7 |year=2003 |pmid=12860534 |doi=10.1177/03635465030310040301 |s2cid=24737981 }}</ref> These exercises are used to increase stability, strength and range of motion of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles within the rotator cuff.<ref name="Waltrip03" /> Passive exercises include internal and external rotation of the shoulder joint, as well as flexion and extension of the shoulder.<ref name="Waltrip03" />

A 2019 Cochrane Systematic Review found with a high degree of certainty that subacromial decompression surgery does not improve pain, function, or quality of life compared with a placebo surgery.<ref name=":0" />

=== Orthotherapy exercises ===
Patients that suffer from pain in the rotator cuff may consider utilizing [[Rotator cuff tear|orthotherapy]] into their daily lives. Orthotherapy is an exercise program that aims to restore the motion and strength of the shoulder muscles.<ref name="Wirth, Michael A. 1997">Wirth, Michael A., Carl Basamania, and Charles A. Rockwood. "Nonoperative Management of Full-Thickness Tears of the Rotator Cuff." Orthopedic Clinics of North America (1997): 59-67</ref> Patients can go through the three phases of orthotherapy to help manage pain and also recover their full range of motion in the rotator cuff. The first phase involves gentle stretches and passive all around movements, and people are advised not to go above 70 degrees of elevation to prevent any kind of further pain.<ref name="Wirth, Michael A. 1997"/> The second phase of this regimen requires patients to implement exercises to strengthen the muscles that are surrounding the rotator cuff muscles, combined with the passive exercises done in the first phase to keep on stretching the tissues without overexerting them. Exercises include [[Push-up|pushups]] and shoulder shrugs, and after a couple of weeks of this, daily activities are gradually added to the patient's routine. This program does not require any sort of medication or surgery and can serve as a good alternative.
The rotator cuff and the upper muscles are responsible for many daily tasks that people do in their lives. A proper recovery needs to be maintained and achieved to prevent limiting movement, and can be done through simple movements.