Rehabilitation of Rotator Cuff Injuries: Integrative Perspectives from Traditional Chinese and Western Medicine

Abstract

Rotator cuff injury is one of the most prevalent tendon disorders of the shoulder, with the highest prevalence in patients over 60 years and in occupations or sports requiring sustained overhead load. It arises from chronic tendon degeneration and repetitive microtrauma, often aggravated by acromial morphology, reduced subacromial space, or scapular dyskinesis. Patients typically present with nocturnal shoulder pain, weakness during abduction and external rotation, and in advanced cases, stiffness or secondary arthropathy. Western treatments include analgesic drugs, structured physiotherapy, shockwave therapy, and arthroscopic repair, where the extent of tendon retraction, degree of fatty infiltration, and expected functional demand largely determine therapeutic choice. Despite advances, high retear rates persist in specific subgroups. Traditional Chinese Medicine (TCM) therapies such as acupuncture, manual techniques, and herbal preparations have been shown in pilot trials to decrease pain scores and enhance range of motion, possibly via modulation of local cytokine expression and peripheral nerve excitability. Integrative strategies are designed to accelerate rehabilitation timelines, minimize reliance on corticosteroids or opioids, and optimize restoration of shoulder strength and endurance. This review evaluates the comparative outcomes of conservative, surgical, and traditional modalities, highlights preliminary signals of benefit from integrative care, and identifies methodological priorities including standardized outcome measures and multicenter randomized trials.