Rotator Cuff Tear Treatment Options

Nonoperative treatments serve as a first-line approach for many patients with rotator cuff tears. This method is especially beneficial for patients with small or partial tears and those with relatively low levels of pain and discomfort. If the demands on your shoulder are low (i.e., your daily activities or job doesn’t involve heavy lifting or high-intensity physical activity), nonoperative treatments could be highly effective.

This treatment plan may involve measures like rest, heat or ice application, over-the-counter anti-inflammatory medications, and possibly, prescribed pain medications. The key to this treatment is the relief of pain and restoration of function without surgical intervention.

However, if the tear is more severe, causing substantial pain and significantly impairing shoulder function, nonoperative treatment may not offer a satisfactory solution.

Lifestyle Modification

Lifestyle modifications can be highly effective in managing the symptoms of a rotator cuff tear. This option suits patients experiencing mild to moderate symptoms and those who can change their daily activities or movements to avoid provoking their pain.

For instance, patients might need to modify their lifting techniques, switch from overhead lifting to lifting at waist level, or even change their sports techniques to reduce shoulder strain. Consistent application of heat or cold packs to the shoulder and maintaining a healthy weight can also ease symptoms.

However, these changes might not be sufficient for patients with active, physically demanding lifestyles or with severe tears causing intense pain or functional impairment.

Physical Therapy

Physical therapy is an integral part of the treatment plan for rotator cuff tears. It is applicable to patients with any size of tear, with a focus on restoring shoulder strength and flexibility.

Therapy often commences with gentle, passive motion exercises to maintain mobility in the shoulder. As pain decreases, active motion exercises are introduced, followed by strength training to rebuild the muscles surrounding the shoulder and eventually, the rotator cuff muscles themselves.

Despite its effectiveness, patients with large, high-grade tears or those not showing improvement after several weeks might require a different treatment approach.

Injections

Corticosteroid injections can be beneficial for patients experiencing persistent pain that is not alleviated by oral medications. These injections can reduce inflammation and provide temporary pain relief, enabling patients to engage more fully in physical therapy.

However, it’s crucial to note that corticosteroids are not a cure; they only control symptoms. Also, repeated use may weaken tendons, making this option less favorable for patients with severe tears where healing the tear is the primary objective.

Bracing/Sling Use

Bracing or using a shoulder sling can help maintain the shoulder in an optimal position for healing and provide necessary support. This treatment option is particularly useful for patients in the acute phase following a rotator cuff injury. However, it should not be used long term as it will lead to stiffness in the shoulder.

If the aforementioned conservative treatments don’t provide sufficient relief, surgery may be recommended. Patients with large or complete tears, younger patients with high functional demands on their shoulders, or those experiencing significant shoulder dysfunction are potential candidates.

Debridement

This arthroscopic procedure is generally for patients with partial tears. The surgeon cleans out the damaged tissue, promoting a healthier environment for the remaining tissue.

Rotator Cuff Repair

In this procedure, the torn tendon is reattached to the head of the humerus (upper arm bone). This is typically achieved using suture anchors, tiny devices that are inserted into the bone to hold the sutures in place.

Balloon Spacer

This is a newer procedure that involves the placement of a biodegradable balloon between the shoulder’s acromion and humeral head. It’s usually recommended for patients with massive, irreparable rotator cuff tears, acting as a temporary spacer while other treatments are explored.

Superior Capsular Reconstruction (SCR)

This procedure is an option for patients with large, irreparable tears. A graft is used to recreate the superior capsule of the shoulder, which can help restore shoulder stability and function.

Reverse Shoulder Arthroplasty

In this procedure, the shoulder joint is replaced with a prosthetic. It’s typically reserved for patients with massive, irreparable rotator cuff tears and associated severe arthritis.

Following surgery, the initial recovery period often involves wearing a sling and initiating gentle range-of-motion exercises. Patients typically resume light activities within 2-6 weeks post-surgery, start light exercise by the third month, and expect a full return to sports or physically demanding work by 4-6 months.

It’s important to note that the success of surgical treatment depends on factors such as the patient’s age, overall health, tear size and chronicity, and muscle quality. Factors such as smoking or underlying medical conditions like diabetes may negatively affect healing and recovery.

Deciding on whether to undergo surgery depends on various factors, such as:

• Age: Older patients may choose conservative treatments due to the higher risks and slower healing associated with surgery.
• Activity Level: Active people, especially athletes, often need surgery to regain full function of their shoulder.
• Size of the Tear: Larger or complete tears are more likely to need surgical treatment.
• Duration of Symptoms: If conservative treatments have not improved symptoms after six months, surgery may be considered.

Although many tears can wait to be fixed on an elective basis, there is a risk that they will enlarge over time, making the surgery more difficult and potentially reducing the chance of healing. For large tears, it is important to repair them within a month or two to give the best chance at success. The longer the tendon is not attached to bone, the rotator cuff muscle will become weak and atrophied, which may make the repair not possible or reduce the chance that it will help if it is repaired.