Prevention and physiotherapy take centre stage in the treatment of shoulder injuries

The shoulder, one of the most mobile and complex joints in the human body, is also one of the most prone to injury. Among these, those affecting the rotator cuff, a set of tendons that stabilise the joint, are the most common, especially in people over 40 or those who perform repetitive overhead movements.

Dr Pablo de la Cuadra, a specialist in Sports Traumatology and Reconstructive Surgery at Ruber Internacional Hospital, emphasises that ‘most rotator cuff injuries are degenerative in origin, although they can also be caused by acute trauma or overuse’. Factors such as smoking, diabetes, obesity, and intense manual labour increase the risk of tendon degeneration.

The specialist explains that the diagnosis combines medical history, physical examination, and imaging tests, highlighting the role of magnetic resonance imaging as an essential tool for confirming the type and extent of the injury. ‘Night pain, weakness and functional limitation are warning signs that should prompt an early medical consultation,’ says Dr. de la Cuadra.

Not all injuries require surgery. ‘In many cases, conservative treatments—physiotherapy and strengthening—achieve excellent results. Surgery is reserved for acute, traumatic tears, or when conservative treatment fails,’ says the specialist.

Physiotherapy, key to recovery
Structured physiotherapy tailored to the patient is, according to Dr. de la Cuadra, one of the pillars of recovery. ‘Proper rehabilitation improves shoulder strength, mobility, and function. There are no universal protocols: each patient needs a tailor-made programme,’ he says.
Supervised programmes and patient education about their injury are also essential to prevent relapses and avoid unnecessary surgery.

Reverse shoulder prosthesis: technology at the service of function
In the most severe cases, when the rotator cuff is irreparable or there is advanced osteoarthritis, the reverse shoulder prosthesis has established itself as an effective alternative.
‘The design of this prosthesis changes the centre of rotation of the shoulder and allows the deltoid muscle to take over part of the lost function. This allows the patient to regain mobility and reduce pain,’ explains the doctor.

Among the main advances are 3D preoperative planning, intraoperative navigation, augmented reality and stemless implants. These innovations allow for more precise placement of components, less bone loss and faster recovery.

‘Shoulder surgery has evolved towards more precise, minimally invasive and functional medicine, focused on restoring the patient's quality of life and autonomy,’ says Dr. de la Cuadra.

Recovery after reverse shoulder replacement is based on a personalised 12-week protocol, with passive and active-assisted exercises that progress towards strengthening the deltoid and scapular stability. ‘We now know that early mobilisation, even immediately after surgery, speeds up recovery without increasing complications,’ says the specialist.
Dr Pablo de la Cuadra, whose practice combines sports traumatology and reconstructive surgery, advocates a comprehensive approach. ‘Addressing the shoulder from a holistic perspective allows us to treat the cause and not just the consequence. The combination of precise surgery, functional rehabilitation and personalised prevention offers the best long-term results.’

Finally, the doctor sends a clear message to those suffering from shoulder pain or limited movement: ‘Most cases are not serious, but early diagnosis and correct treatment make the difference between a full recovery and a chronic injury.’