【case 06】Recovering Shoulder Function After a Partial Rotator Cuff Tear

Case Overview

A 45-year-old male baseball coach presented with persistent right shoulder pain and weakness when lifting his arm. His symptoms had developed after baseball pitching training and progressively worsened over several months.

The condition began to interfere with everyday activities, sleep, and his ability to perform baseball-related movements.

After clinical assessment and MRI examination, the patient was diagnosed with a Grade I partial supraspinatus tendon tear accompanied by subacromial bursitis.

The treatment approach combined pain management, acupuncture, soft-tissue techniques, rehabilitation, physical modalities, and progressive return-to-sport training.



Patient Presentation

The patient initially developed pain around the outer aspect of his right shoulder following pitching training.

Over the following three months, the pain persisted and became more severe during the preceding month. Arm elevation became increasingly difficult, and the patient experienced pain that disturbed his sleep.

He reported difficulty with everyday activities including:

• Raising the arm overhead

• Combing his hair

• Dressing

• Pitching

• Performing normal shoulder movements

His initial pain level was VAS 7/10.

Clinical examination demonstrated positive:

• Jobe test

• Neer sign

• Hawkins sign

MRI examination showed a partial supraspinatus tendon tear involving less than 50% of tendon thickness, together with a small amount of subacromial effusion.

The clinical diagnosis was:

Western Medicine Diagnosis

• Grade I partial right supraspinatus tear

• Right subacromial bursitis

TCM Diagnosis

• Shoulder Bi syndrome

• Tendon-vessel injury

• Qi stagnation and blood stasis syndrome



Why Was the Shoulder Function So Limited?

A partial rotator cuff tear can affect both pain and shoulder function.

In this case, the patient experienced not only localized shoulder pain but also weakness and difficulty with overhead movement. The combination of tendon injury and subacromial inflammation contributed to restricted movement and reduced functional capacity.

For an individual whose daily activities and professional work involve the shoulder, restoring movement and strength is an important part of recovery.



Comprehensive Treatment Approach

The patient underwent an 8-week treatment program combining several therapeutic approaches.

1. Pain and Local Tissue Management

The treatment plan included ultrasound-guided intervention to the right subacromial space and perisupraspinatus tendon, followed by a course of sodium hyaluronate injections into the subacromial space.

The treatment plan also incorporated physical modalities intended to address inflammatory edema and local tissue symptoms.

2. Soft-Tissue Therapy and Tuina

Right shoulder soft-tissue release and Tuina were performed three times per week.

The aim was to address soft-tissue tension and support improvement in shoulder mobility.

3. Acupuncture

Acupuncture was performed three times per week as part of the broader pain-management and rehabilitation program.

Rather than being used as an isolated treatment, acupuncture was incorporated into a multidisciplinary approach alongside other interventions.

4. Extracorporeal Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) was performed once weekly for four sessions as part of the treatment plan.

5. Progressive Rehabilitation

Rehabilitation progressed according to the patient's symptoms and functional recovery.

During the acute phase, lasting approximately one to two weeks, rest and avoidance of overhead movements were emphasized.

After pain reduction, rotator cuff isometric exercises were introduced.

At approximately three weeks, the program progressed to:

• Range-of-motion training

• Progressive resistance exercises

• Rotator cuff strengthening

• Functional shoulder training

As shoulder function improved, the patient gradually returned to pitching-related training.



Functional Progress

The patient's clinical measurements showed substantial improvement during the 8-week treatment cycle.

These findings indicate significant improvement in pain, range of motion, shoulder strength, and functional ability.



Return to Baseball Activity

Before treatment, the patient was unable to pitch and experienced limitations in activities of daily living.

Following the treatment and rehabilitation program, shoulder movement and strength improved sufficiently for him to resume pitching training and return to coaching activities.

At the three-month follow-up reported in the case record, there was no recurrence of symptoms.



What This Case Highlights

This case illustrates several important principles in the management of shoulder injuries.

Pain relief is only part of recovery

Reducing pain is important, but functional recovery also requires restoration of movement, strength, and the ability to perform meaningful activities.

Rehabilitation should progress gradually

The rehabilitation program moved from protection and symptom management toward mobility, strengthening, and sport-specific activity.

Multiple treatment approaches can be integrated

The treatment plan combined acupuncture, Tuina and soft-tissue techniques, physical modalities, medical interventions, and progressive rehabilitation rather than relying on a single treatment method.

Return to activity should be progressive

For an athlete or physically active patient, returning to normal activity is not simply a matter of waiting for pain to disappear. Movement, strength, and functional ability also need to be considered.



Shan Clinic Approach

At Shan Clinic, musculoskeletal cases can be assessed from multiple perspectives, including symptoms, physical function, movement limitations, and activity requirements.

Depending on the individual condition, treatment may incorporate pain management, acupuncture, manual techniques, therapeutic exercise, rehabilitation, and progressive functional training.

The objective is not only to address symptoms but also to help patients progressively restore movement and function.



Clinical Outcome

After an 8-week comprehensive treatment and rehabilitation program, the patient demonstrated marked improvement in:

• Shoulder pain

• Shoulder range of motion

• Rotator cuff strength

• Daily functional activities

• Baseball-related performance

The case record reported no recurrence at the three-month follow-up.

Important: This case represents an individual clinical outcome and should not be interpreted as a guarantee that the same treatment combination or outcome will apply to every patient. Treatment should be determined according to individual assessment and clinical circumstances.

Medical Case Disclaimer

This case study is provided for educational purposes only. Individual symptoms, diagnoses, treatment plans, and outcomes may vary. It is not intended to replace professional medical assessment or individualized treatment.