Medical Management of Rotator Cuff Injury

Initially, during the first 48-72 hours after the injury is sustained, use the ‘RICER’ treatment regime:
~ Rest – abstain from anything that aggravates the injury, or from the activity that may have caused it, i.e. swimming
~ Ice – apply ice to the shoulder for 20 minute periods at least three times a day
~ Compression – bandage the area
~ Elevation – perhaps not so necessary for shoulder region but maybe a sling if the pain is bad?
~ Refer – visit a medical practitioner ASAP

After two days of RICER have elapsed, apply heat to the area, e.g. a heat pack or heat lamp. This will help increase blood flow to the injured area. Massage also helps with this as well as helping to minimise the formation of scar tissue.

Take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which will reduce pain, fever and inflammation. Take daily over a period of 6 weeks.
NSAIDs work by inhibiting the enzyme cyclooxygenase, which catalyses the formation of messenger molecules involved in the inflammatory process, such as prostaglandins.

For continued pain and limited functionality due to persistent inflammation an injection of corticosteroid/cortisone (a steroid) into the subacromial space of the shoulder may be needed. This acts as a powerful anti-inflammatory agent by acting at the DNA level (ie binding directly to DNA) to down-regulate the production and function of immune/inflammatory cells and mediators such as macrophages and eicosanoids.
They do however have a number of side-effects, so must be used only if absolutely necessary.

Once the pain has been resolved, it is vital to perform specific strengthening exercises to ensure return to function.
Strengthening of the shoulder rotator cuff muscles is best performed by isolating each muscle group and selectively training that muscle. The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. It is best strengthened by holding a hand weight in front of the body, with the arm flexed to 90 degrees, and rotating the hand to touch the belt. The exercise can be performed while lying on your back with the elbow close to your side and flexed ninety degrees. Lift the weight until it is pointing toward the ceiling and then lower it slowly.
The supraspinatus is strengthened by holding a light weight (initially 3-5 lbs) out straight in front of the body, with the thumbs pointed toward the floor. Slowly elevate the weight to above the head.
The infraspinatus is strengthened by holding the weight in the position of the ski pole just prior to planting the pole. By rotating the arm from the neutral straight ahead position, to the externally rotated (out to the side) position, the infraspinatus and teres minor are strengthened. Again, this exercise can also be performed while lying on your side with the elbow close to your hip, and flexed ninety degrees. Rotate the weight until it is pointing toward the ceiling. Shoulder exercises are best performed with relatively light weights and multiple repetitions.
The logic behind stretching and strengthening the inflamed rotator cuff in order to speed healing and functional performance is as follows: the inflamed tissue is characterized by increased fluid between the cells, increased numbers of new blood vessels and inflammatory type cells. As a result of this inflammatory reaction, new collagen tissue is laid down in an effort by the body to heal the injured tissue. If the shoulder is immobilized during this time, the new collagen is laid down in a disorganized fashion, creating scar. The goal of gentle stretching, strengthening and anti-inflammatory medication, is to stimulate the cells to lay down collagen along the lines of stress, forming normal strong tendons. The combination of a good warm up, gentle stretching, strengthening below the limits of pain, icing after working out and anti-inflammatory medication has been consistently shown to speed recovery time in the strongest possible fashion.