Rotator Cuff Tear – Case Report

History: The patient reported the sudden onset of left-sided neck pain approximately two weeks prior, with no identifiable mechanism of injury. She initially consulted her primary care physician and was prescribed a course of prednisone. Following this, she noted a significant decline in shoulder function, specifically an inability to raise her left arm overhead. The patient was referred to an orthopedic specialist and underwent imaging, which revealed a supraspinatus tear with 5 cm of retraction, deemed irreparable. She received a cortisone injection, which provided significant pain relief. Since then, she reports improved sleep and gradual improvement in shoulder mobility; however, she continues to experience significant difficulty with overhead reaching. The patient has a history of a shoulder injury approximately 10 years ago following a fall, which was also diagnosed as a tear. She was able to successfully rehab the shoulder at that time and had been functioning without limitations until the recent onset. Currently, the patient is hoping to postpone or avoid a total shoulder replacement and is seeking conservative options to manage pain and improve function.

Functional Limitations:

• Reaching arm overhead
• Blow drying her hair
• Lifting

Objective Measurements:

• Active Range of motion-L shoulder flexion 95deg, abduction 95deg, ER 60deg IR 80deg. Cervical active range of motion was within normal limits and without pain.
• Strength- L shoulder flexion 3/5 abduction 4+/5 IR 5/5 ER 3+/5
• Palpation- no significant area of tenderness, mild increased muscle tone in L upper trapezius

Treatment: Treatment primarily focused on strengthening and neuromuscular re-education to improve stability at the glenohumeral joint. Emphasis was placed on optimizing shoulder mechanics during overhead movement and training compensatory muscle groups to assist with the loss of supraspinatus function. The patient experienced one episode of increased neck stiffness after moving heavier items around the house. In response, treatment was temporarily adjusted to include more manual therapy, specifically soft tissue mobilization and cervical mobilizations, to restore cervical mobility. As the patient progressed in strength, therapy transitioned to more functional tasks such as lifting and carrying, with the goal of preventing future cervical strain during heavier activities.

Results: The patient was seen for 23 visits. By discharge, she had regained full range of motion and was pain-free during all daily activities. She reported only a 7% disability score on the QuickDASH functional assessment. She was able to lift 5 pounds overhead and could lift and carry over 20 pounds without pain or compensatory movement. Although shoulder flexion weakness remained, the patient demonstrated the ability to recruit other muscle groups effectively and expressed confidence in her ability to manage and adapt to her limitations.