Targeted Assessment, Explanation and Goal Setting for Cuff Tears

The subjective exam should cover the patient's expectations of physiotherapy, motivation, previous experience, catastrophizing, self-efficacy, mental health, activity levels and the activities that matter most to them. Questionnaires such as the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire or HADS can help when needed. When several non-modifiable negative factors stack up, an early second opinion may be better than weeks of physiotherapy, though psychosocial factors may also predict a poor surgical result. Treatment should focus on clinician factors, as these are the easiest to change. The speaker explains the biomechanics on a whiteboard, links the explanation to the patient's own limits, and builds exercises around meaningful tasks, illustrated by a patient who only felt better once her program included brushing her hair. The summary: know the radiological signs, screen for prognostic factors, be aware of your own bias toward rehabilitation, discuss surgical options openly, and make sure the patient can commit to daily exercise for at least 12 weeks.