Treating Rotator Cuff Tears Without Surgery| Episode 52
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- čas přidán 13. 10. 2019
- Partial and full-thickness rotator cuff tears are common shoulder injuries. Typically surgery is suggested to repair the rotator cuff, but can conservative treatment produce similar outcomes?
Show Notes:
Boorman R, More K, Hollinshead R, et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elb Surg. 2018;27(3): 444-448. www.jshoulderelbow.org/articl...
Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elb Surg. 1999; 8(4): 296-299. www.sciencedirect.com/science...
Connor P, Banks D, Tyson A, et al. Magnetic Resonance Imaging of the Asymptomatic Shoulder of Overhead Athletes: A 5-Year Follow-up Study. Am J Sports Med. 2003; 31(5): 724-727. journals.sagepub.com/doi/abs/...
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I'm a chiropractor with an interest in rehabilitation, tendinopathy, and chronic pain. I graduated from the University of Washington with a Bachelor's in Science and from Palmer Chiropractic College West with a Doctorate in Chiropractic.
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#rotatorcuff #rehabilitation #shoulderpain
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Okay I’ve been having been having shoulder pain for like a year but it comes and goes but when it comes it hurts like hell
Can be common for shoulder issues. Could be something that is irritating the shoulder and then goes away (for example, doing shoulder press then not working out for while)
@@MichaelBraccio YES shoulder press really triggers the pain. I don’t have limited rom but my rotator cuff hurts sooo much
I was taking a shower and while reaching for something in front of me (35° angle to the left) I felt a pain in my shoulder and later at the gym when going for I wasn’t able to get my arm locked in to hold the barbell for squats without immense pain, however I was still able to do lat pull downs, bicep curls, chin ups with no problem is this something I should be worried about and is this a sign of a cuff injury? Caused by sudden movement?
Might be worth it to have it evaluated. But it sounds like the shoulder is tolerating some load with the pull downs, chin ups, etc which is good but something about the shoulder position of the squat is irritating it.
So hard to know if I should have surgery or not. I have great motion and range, very little pain. But I want to play pickleball...and tennis. I really do not want to have surgery. One surgeon wanted to do Reverse Shoulder Replacement...CRAZY. Two other surgeons said I could do rotator cuff surgery, but could promise no improvement. MRI does show 3cm full thickness tear in supraspinatus. What do to?
i’m not sure if i torn my rotator cuff but i recently fell on my bike and my shoulder was killing me. after a week the pain is very minimal, however my front deltoid and trap on my right side looks less than the one on the left. what do i do
Same for me except i had a week pain and felt like injured my shoulder while doing chest pull over. I have no real pain since but when I workout any overhead movements,i do feel a little
I tore my rotater cuff a year ago MRI showed 2 tears I didn't want surgery 6 months physical therapy I have full range of motion I can still feel pain when doing awkward movements but the pain goes right away I couldn't even move it when the accident happened.
Any solution? I'm suffering with same problem
@@Saiprasad22 I'm sorry pt worked wonders and I still exercise the shoulder right up to pain I lost 15% usage in the shoulder but jus doing normal stuff I'm fine so 7 to 8 months my shoulder feels great I can even sleep on it and my shoulder still has two tears in it a slap tear and suprinatus something tear sorry for spelling.
@@silveradochevy2474 hey thank you.. what is meant by PT ?
@@silveradochevy2474 did you had surgery? Or did you recovered by your self?
@@Saiprasad22 bye myself I got hurt on the job Drs were amazed at my range of motion without surgery but I stress start exercising that arm as soon as you can there's non surgery exercises on CZcams to make your shoulder strong.
You've given me hope. Thank you.
Glad to hear it. I'm hoping to make a couple more shoulder videos coming soon!
how is it going?
@@tymocreations Going very well. I actually didn't have a tear. I had an inflammatory response to the C-Vaccine. In the months following this comment it spread to all my joints and muscles, even my digestive system. Prednisone helped until my body could start to deal with it. Spent a year mostly in bed or on a couch in pain. Thank God for family and friends. Cheers man and thanks for asking.
When I lay down on my back and try to take my arms overhead and straighten then behind my left shoulder hurts while I am able to straighten my right arms all the way. It’s been a year 😢 what could it be?
Yes very good i glad i fou d ypur video,it has give me hope, tho may i ask when doing exercises to help strengthen my shoulder (after a fall i hurt it,think i tore the cuff 'front shoulfer ring hand side,and ive got chest pain in my pec major and scapula,and running down my tricep') how often should i do my exercises and stretching exercises ? Thankyou
Difficult to say because it varies between individuals.
Yesterday I was throwing a cricket ball with my right hand and suddenly i experienced a tremendous pain in shoulder joint and i was not able to take my arm back to its orignal position ,but after some struggle it automatically came to its orignal place but I am not able to move it up and back .... Do I have a rotator cuff tear or something else ? Sir It would be a help if you may reply .
I’ve had a problem with my rotator cuffs for both arms for about 2 years now they’ve always ached and popped but i could live with it I never noticed how much of a problem it was until I started getting into boxing I went to the doctors and they gave me some exercises to do I’ve been doing them for the past month and it feels like my shoulders have got worse is surgery my only option if I’m to carry on with boxing?
What did u do then ?
STOP BOXING - YOUR HEALTH IS MORE IMPORTANT !!
Hi, thank you very much for your video. I had a hard fall as I was going home after a busy day, on an electric scooter, I slipped and don't know really how the fall was, but I had a lot of pain in the shoulder right away. After about two or three days of not being able to raise my arm at all, I have slowly regain some range of motion. However I gather I injured the supraspinatus, because I cannot extend the right arm at 90 degrees without raising the shoulder. Also, when I lift my arm with the help of the other, and I stay at 90 degrees, I can see the profile of my two shoulders is somewhat different, the injured shoulder shows like a small dip or dent, whereas the others circumference seems to follow a perfect arc. I have been seen a full range of information, some say it will never heal on its own, others that it might. I am hopeful thanks to your video that in case I might end up needing surgery, the fact that I delay it is not such a big issue. I feel the condition is improving but very slowly.
hey, my situation sounds very similar to yours. any update on your shoulder? did it heal or did you end up having surgery for it? thanks
@@sy17_ Hi, I am glad to give you my situation right now, I remember how difficult that time was with the uncertainty that you don't know how it is going to be in the long run. So, all in all, I never had an operation, since last time, I had another fall, and I landed on the other arm. Both tendons then ended damaged, as far as I reckon, but strangely enough, the first one healed much better, even when the fall was far worse. I do feel some discomfort but I recovered the full range of motion, and everything seems fully functional, though I do feel some pain, particularly on my left side, which is the one I injured after the second fall, which was way lighter. If I can give you some advice: go swim, I remember during the first few months I went for a swim once, and the day after I thought it was a really bad idea because I was in such a pain. It turns out, only a few days after, I felt waaaay better, the thing started to heal I reckon from that moment on much better.
@@pablojlascano8322 I really appreciate you taking the time to reply and I'm glad that your situation improved so much. It's relieving to hear. And iv been considering getting back into swimming for a while so it seems a good time to ease into it. How long did it take for you to heal to a point where you could use it how you could before? with exercise/day-to-day tasks
So I fell backwards and put my arms behind me to catch myself, felt horrible in both shoulders but mainly my left had mri on left and was told it was torn all the way through and about 3 centimeters from the bone so no surgery but need a total reverse shoulder replacement. Which I am not going to do, if I follow and do shoulder exercises can I get most of my shoulder usage back? Any advice would be deeply appreciated!
Ouch! Sorry to hear about the shoulder injury. It’s hard to predict the future (with either surgery or conservative care). Find a provider that is on the same page as you and will help you work towards your goals with the shoulder. Best in recovery.
How r u doing, I have rotator cuff tear on my right shoulder, while I was painting. Too much pain while sleeping, it has been 2 months now, acupuncture said tendon came out , he fixed it within 5 minutes, said don't take your hand back go for pt.
How r u doing, I have rotator cuff tear on my right shoulder, while I was painting. Too much pain while sleeping, it has been 2 months now, acupuncture said tendon came out , he fixed it within 5 minutes, said don't take your hand back go for pt.
Just saw this video and it's great! Over 3 years ago I had an MRI show a full thickness 1mm supraspinatus tear. The surgeon (of course) recommended surgery but I went 3 years without symptoms....but now, unfortunately, I have some minor shoulder pain and worse bicep pain, particularly after curls. The tear is age-related, in my non-dominant arm and I can lift my arm as high as it can go. In your experience is it common to have bicep pain in conjunction with a cuff tear? As you can imagine I'm wanting to opt for conservative, non-surgical help.
Thank you! I'd say that it can be a common issue, as it might be a compensation thing that is loading the biceps tendon. czcams.com/video/3HMEJdFdwJg/video.html
Thanks, i have full thickness tear, and bone spurs, what exercises should be done without surgery?
Hard to say specifically as it depends on tolerance.
My range of motion hasn’t changed at all but my left shoulder hurts when I do shoulders at the gym and when driving. I also have to be careful the way that I lay but the pain isn’t bad at all. When I do circles with my arms, my right makes no noise but my left makes a tiny bit I’m thinking I have a small tear. I just don’t want to exacerbate it. I’m 20 by the way.
Could be a tear but might not (lots of people have rotator cuff tears but no changes in pain or function). I’d try some rotator cuff strengthening to see if it helps with the pain and clicking. I’m actually uploading a video tomorrow with some exercises that might be helpful.
Michael Braccio i really hope it isn’t. Surgery is the thing I don’t want I have to do at all. A. The scarring and B. The money. This has me hopeful though. I’ll be looking out for your video.
@@travisspaulding9540 Even if it is a rotator cuff injury, doesn't mean surgery. Many can be treated without surgery.
Here is the link for the new video! czcams.com/video/tFjelMmGsHg/video.html
I'm suffering with same probably
I am suffering with the exact thing as Travis. But on the right shoulder. I probably got this injury from volleyball spiking. I rested for 1 1/2 months now. But there is a slight ich of pain. I am able to do all the tasks even play volleyball. It's just that it making a tinu bit of sound. Please let me know what to do i have no idea. Btw Iam 23 now
Can someone help me, i injured my shoulder today, i can still lift however, when im doing dips there is massive amount of pain in my shoulder
Sorry to hear about the shoulder pain! Best thing is for someone to actually look at the shoulder to see what is going on. But the biceps tendon and supraspinatus tendon are at the front part of the shoulder and can be irritated with dips.
hey! I don't know if this is a rotator cuff tear, yesterday I did alot of shoulder exercises like Arnold Press and shoulder press exercises, also alot of push ups, could it be a rotator cuff tear or just a sore, its in both of my arms please reply thank you :)
It could be either. It's definitely not uncommon to be sore in the shoulder after an intense upper body workout.
How r u doing now?I have rotator cuff injury.
i just have pain nd popping sounds in my left shoulder when i am doing overhead dumbell for triceps or barbell shoulder presses the back one. I am not able to lift heavy in these exercises. I literally dont know how to make this okay 😢
Sorry to hear that! Getting checked out by a healthcare provider can be useful in figuring out the best treatment approach for you is.
I feel hard forward like a pushup and jammed up my shoulder , 2 1/2 years now.
Completely tore the cuff in half. So much pain..
No exercise will fix a cut muscle or tendon..
Thank you Dr Braccio anf of course appropriately Braccio means Arm in Italian. God Bless!
Of course, Tony!
My shoulders still have that burning sensation but I can move it just fine now is it still damaged or is this the best it’ll get ?
Depends on what is causing the burning. Usually the structure is a poor indicator of pain in the shoulder (for example shoulder pain doesn't mean a rotator cuff tear and vice versa).
Please advise whether below MRI report is treatable without surgery? Injection?
Partial tear or sprain of supraspinatus just before insertion
Minimal gleno hum and ac cl joint effusion
Minimal sub a, sub Cora, sub delt bursal collection
Partial tear/sprain of inferior Glen hum ligament with effusion in vicinity.
It was due to weight training 🙄 sleep is hell with pain.
Unfortunately we don’t have good criteria for who should get surgery and who shouldn’t. It’s really a joint decision between you and your healthcare provider which direction they think will be best.
@@MichaelBraccio my ortho has advised to immobiliz the the shoulder to heal the tear. While other says do exercise, it is confusing. Same for ice treatment or heat pack? Injury happened around 3 months back.
@@flyhigh5066 You can always get a second opinion to see which options are best for you.
@@MichaelBraccio what is your opinion
@@flyhigh5066 Unfortunately without all of the information (going through a thorough history and exam), I can't give an opinion that would be helpful.
thanks for making this video
You’re welcome!
I have had surgery for right torn rotator cuff but its tore again. My left is now tore as well. Its so painful
Ouch! Sorry to hear that. Hopefully you have a speedy recovery.
6years ago while im playing basketball,i slapped the ball as hard as i could to steal it from our opponents hand.suddenly my shoulder just tear and its horribly painful..i didnt get any treatment at all..just a simple massage by my wife.the pain was gone but when i use force to my shoulder(specially dribbling or passing or rebounding,)it eventually tears..and an hour or two later,pain is gone again..what do you recommend me doing doc?thanks in advance
That's difficult to say. The best thing you could do is get it looked at by a healthcare professional to see what the most appropriate treatment would be.
How r u doing, I have rotator cuff tear on my right shoulder, while I was painting. Too much pain while sleeping, it has been 2 months now, acupuncture said tendon came out , he fixed it within 5 minutes, said don't take your hand back go for pt.
Sorry maybe I’m misunderstanding, is there a question here?
In the linked paper, only patients with "chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging)" are selected for the cohort,
do ppl who have injuries from physical accident/a fall, and displayed symptoms for > 3 months count as chronic?
Great question. Acute/chronic typically only refers to the duration that someone has been experiencing pain. Typically, the mechanism is referred to as traumatic or atraumatic rotator cuff tears. So, someone could have a traumatic chronic rotator cuff injury.
Question i am a carpenter and the mri showed rotator cuff tear.
So avoid surgery and go back to work?
It's hard to say. An MRI with a rotator cuff tear without pain isn't uncommon. But that's where having a conversation about your specific presentation to figure out what is the best treatment approach for you.
What was the pain level in the 2 groups after surgery in the 1 group vs non-surgery group? The same pain levels?
I don't believe that this study specifically looked at pain levels. But generally similar studies have found that pain level is similar in the long term (possibly slightly better short term results in those with surgery).
@@MichaelBraccio
You think that(pain) would be one of the variables tested & tracked?
Take time off obviously , hang stretches from pull up bar , get get yourself a racquetball and massage the pain out. Helps me every time I get shoulder problems
How can I lift weights in gym with injury?? Answer would be much appreciated
That’s so tough to say because everyone tolerates different loads.
Hello sir,
I am. Having shoulder pain from past one month i have consult nuro and general physician doctors but dont relief from shoulder pain is their any solution for this i have got pain at late nights on left hand side
Please give me a solution for this
Thank you sir.
Depends on what is going on. Getting a thorough assessment by a healthcare professional will help figure out what next steps you need to take.
I am 5 months post rotator, labrum and bicep tenodisis. Still struggling. While I've made some progress I'm still in PT. Hopefully will get better.
Wishing you the best in recovery! Slow and steady!
If you’re a rich athlete or were injured at work (workers comp) you get surgery for immediately. The rest of us get an explanation as to why we won’t get surgery.
It's not that simple. There are a lot of elite athletes that have structural changes in the shoulder but don't have any pain. Frequently they will be doing non-surgical care behind the scenes to see if they can avoid surgery, especially since surgery doesn't necessarily mean they will return to sport or return to the same level of performance.
If you're interested, here are a couple of articles:
journals.sagepub.com/doi/abs/10.1177/03635465020300012501?journalCode=ajsb
www.ncbi.nlm.nih.gov/pmc/articles/PMC5825345/
@@MichaelBraccio Thanks! I'll take all the help I can get.
Did you watch the video
Had a bad fall 12mths ago still in physio hoping I get a release soon.
Exactly
I have a partial thickness tear in the supraspinatus and my doctor hasn’t really given me any time range or exercises to help it heal.
I have full range of motion and it hurts sometimes. Sometimes when I lift something from my left arm and sometimes the pain just comes randomly. But most of the time. It’s pain free.
So I can it heal without surgery?
Everyone obviously responds differently so it is challenging to say with specific cases. But in the research, we see that conservative treatment can be beneficial for those with rotator cuff injuries.
My shoulder has pooped out of place like 10 times in the past 12 months does this mean I have a shoulder rotator cuff tear?
Potentially. You’d have to get it evaluated to figure out what’s going on.
Is there one video on the web that shows what to actually do if you have a tear for treatment. My shoulder has killed 24-7 with anti inflammatories and rest. So I’d like to know what to do .
Hi there, how are you now …I injured my left shoulder when doing bench press at the gym , few days before I had some pain but I ignored it and kept exercising now the pain goes in the left biceps too not sure what muscle I have injured
There are a lot of factors to consider with a rotator cuff tear that can influence the exercises used for treatment (or if surgery is necessary). So there isn't one progression that is used, but many options that need to be tailored to the individual. But here's a video that demonstrates a loading progression for the supraspinatus: czcams.com/video/RkJwKJujmh0/video.html
I am 13 years old. I did 100 pushup yesterday and my tendon hurts in both arms, but when I massage it I get relief. It hurts only a little but while I rotate my arms. Is this a rotatory cuff tear ? please reply
Probably not. You just did 100 push ups!
@@MichaelBraccio lol
I think I got a cuff tear bcz I can't raise my hand and move it properly and it's purple I got it while playing football should I go to hospital??
You should get it evaluated
I had a wrestling injury in high school 13 years ago. My shoulder hurts occasionally, it can't handle very much weight before a sharp pain forces me to drop it. My range isn't impaired though
To me there seems to be a lot of conflicting information on rotator cuff tears , what I can't understand is if the rotator cuff tendon is completely dislodged from the bone how can physiotherapy help the situation to get the shoulder functional again if the actual tendon is not sewn back to the bone again
For example if the cables that move a lift upwards become broken , there is no way the lift will move upwards again unless the cables to the lift are repaired .
I can understand partial tears of the rotator cuff muscles repairing with time but I cant understand how a complete tear can repair itself when the muscle has moved downwards and it is not attached to the bone .
There is redundancy in the muscles, especially in the shoulder. So either the other rotator cuff muscles or the deltoid will compensate for a supraspinatus tear.
@@MichaelBraccionot without a butt load of pain. As we age...eventually you will need replacement or repair.
The doctor diagnose me with rotator cuff tear I had shoulder impingement for 6 mos. Mild weakness and mild pain I do have full range of motion but I don't to abuse it.. Will it heal?
Depends on multiple factors. But in general, most rotator cuff tears have a positive outcome.
I dont want surgery to avoid alteration. And hoping that the body has healing mechanism about it. Thanks sir.. God bless😊🙏🏻
@@ki8417 any updates? How have you been feeling. I have similar issues
@@richellehutchinson963 little better but mild weakness, clicks and very minimal pain
I have a very limited range of motion in my right shoulder. Burning pain in shoulder that shoots down into my arm and causes tingling in my hand. I have not been able to sleep on that shoulder for at least a year, before I lost an almost complete range of motion with pain.
Sorry to hear about the limited range of motion and tingling! Find a healthcare provider near you that can evaluate what is going on.
Has your ability to be normal with it ever come back?
How are you now?
@@ki8417 I am doing a lot better. I just exercised my arm using the natural movement, rotation as much as i could stand. I read that the pain indicates that the calcium is breaking up, that's probably why I was in so much pain before.. I have most of my range of motion now but still got a lot of work to do on my over all health of my muscles, joints, etc.. Thank you for asking!
@@bestlifenow777 good to hear that I hope I'll be fine soon
Anyone here injured the shoulder while doing bench press? My left shoulder is killing me the pain is going from the front of my shoulder down the left biceps external area forearm wrist and fingers, I failed the empty can test not sure what muscle I have injured
Shoulder injuries with bench press is a common injury. It’s best to go through an evaluation to figure out what is going on and the best treatment approach. Wishing you the best!
Sir two years back my left shoulder was dislocated doctor told me take rest, after 15 days I was recovered , recently it dislocated two times between 15 days doctor told me surgery is needed , without surgery how can I recovery my rotatry cup recovery and muscles strong please help me sir
This is definitely a conversation to have with your doctor, as they know more about your specific injury history and can do an assessment to figure out the best plan of care for you.
Was doing wrestling drills and partner spazzed out so we rolled the wrong way so that we landed with him on top of me and my shoulder over rotated while my elbow was bent 90.
It hurt but my adrenaline was up. Now at home and can barely lift arm above shoulder. Put on a sling and Trying to stay positive since I still have work and school.
Ouch! Hope you recover soon!
How’s it feeling now? Sorry that happened btw, I am concerned I tore my rotator in BJJ so I feel your pain.
Sir please help me
Sir u was doing spider crawl and i slipped my right shoulder and my whole body weight was on it I was gone to doctor but he said it's not bone injury it's deltoid injury muscle injury and it's been3 months it is not repearing sir plz help me with this
It's best to work with someone who can take a history and exam to give you individual recommendations.
I just tore my right rotator cuff now I can't put my arm behind my back or lift it with my arm out and thumb pointed down doc told me it was going to take anywhere between 2-3 months to heal and rehabilitation just for it to get better and he said I would probably always have issues with it. Apparently I'm lucky but unlucky because it won't need surgery but it's bad enough that ill always have some level of pain even after healing, I might never be able to put my right arm fully behind my back.
Sorry to hear about the injury! Might be helpful to have someone guide you through a rehab program. Hope you have a speedy recovery.
How are you now? I have injured my left shoulder at the gym ( bench press) I did the thumb down test( empty can ) and failed miserably now the pain goes down in the left biceps
@@nykko73 I just let my arm rest for a month just now got back in the gym since it happened I've just been doing very light lifts and lots of stretches I just got back up to being able to do a pull up but very particular motions cause my arm to spaz, and it gives out or hurts I also noticed when I focus exercise where the tear was the burn is way more noticeable even with just the lightest resistance band I got. I need to go back to the doctor still and get an update on it and see how its healing. But the best advice I can give you is just stretch where ever you got hurt at a lot. don't try and lift your normal weight basically cut back and focus on cardio and flexibility while you're healing. and if you do want to lift heavy do exercises targeted on just the opposite side of your body its a plus if your dominant arm got injured because it makes you more symmetrical. My left arm has made leaps and bounds in progress made like a years' worth of gains in just this month just because I started using it more than my right.
@@maliciousintent6982 thanks for your quick reply, well i am planning to get an MRI first to understand what is going one there..in the meantime i do a bit of cardio and legs+abs , i have shoulder pain when running on the treadmill is that normal?
@@nykko73 my shoulder also sometimes aches as well when running, but it did that before I ever tore my rotator cuff, I find it helps to stabilize your shoulder. Either with compression wraps or consciously holding it in place. I do the later and make sure I'm always focusing on holding my shoulder in the right spot. I'm too claustrophobic for compression. It also helps to vary your breathing when running don't just keep the same in out count.
I still don't know how to treat rotator cuff tears?!
Did you have a specific question? This video is an older video, but it shows an exercise progression that might be helpful. czcams.com/video/HQ_6eVE8wuY/video.html
@@MichaelBraccio - Well I was looking for what exercises I can do to strengthen what I suspect is a partial tear. Im afraid im slipping into atrophy. It would be nice to do some high rep, low weight exercises to strengthen the area, but I dont want to do some that will cause more damage.
What would happened if don’t get in treated
It's difficult to predict the future. But this study found that surgical and non-surgical treatments produce similar outcomes at 5 years. www.jshoulderelbow.org/article/S1058-2746(17)30669-9/fulltext
I've been doing therapy for months and things are worse not better.
Maybe get a second consult? Have to find out why things aren’t responding/getting worse.
I’m 17 and somehow tore both my rotator cuffs been like this for at least 3 years.. it started with my left everything I would throw a left hook or sum sometimes my shoulder would just go out reall easily and hurt really but I can put it back in place myself and the right starter maybe a little over a year ago.. idk if it’s some kind of genetic thing or if I tore them doing stupid things
Genetics can play a role in shoulder stability. But it's better to have a doctor do an evaluation to figure out what's going on so you can get the appropriate treatment.
No mention of what the conservative non-surgical treatment is.
It's a fairly broad category of treatments, but the primary treatment is exercise.
Rotator cuff tear can cause wiwing scapula
It's not quite that simple.
Please… for the love of god… blink man 😂
Never! 😂
What are you doing with your hands, stop it!
Sorry, I just get too excited and can’t control my hands.
Distraction: too much talking with your hands.
Sorry about that