What is the initial treatment for a rotator cuff tear?
Because many rotator cuff tears do not need surgery, the initial treatment is usually with conservative measures. While the size of the tear may not change with conservative treatment, the symptoms often diminish. In some cases, usually a traumatic rotator cuff tear in a younger patient, early surgery will be recommended. However, the standard treatment of a rotator cuff tear is to start with conservative measures.
The first steps of rotator cuff treatment include:
- Physical Therapy
Physical therapy is the most important step in the treatment of a rotator cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder function. A few meetings with a physical therapist can help teach you exercises to help alleviate and prevent a recurrence of your shoulder pain. - Anti-Inflammatory Medications
Medications are most helpful at controlling the symptoms of a rotator cuff tear. Simple anti-inflammatory medications can be taken regularly for a short period, and then be used when symptoms of a rotator cuff tear flare up. - Cortisone Injections
Cortisone injections can be incredibly helpful at limiting the acute inflammatory process and allowing the patient to begin therapy. It is important to participate in the therapy and exercises even if the shoulder feels better after an injection. The therapy part of treatment will help prevent a recurrence of symptoms.
What treatments are available if I still have symptoms?
These conservative measures may not be effective in all patients. In general, a good effort at conservative therapy is first attempted, especially in older patients or in patients who have chronic (long-standing) injuries. In younger patients who have an acute, traumatic injury, sometimes surgery is considered early as the likelihood that conservative treatment will help is low. Surgery is also considered in patients who have tried conservative treatment, and still have difficulty with their shoulder.
For more information on what factors are used to decide when rotator cuff surgery is necessary:
There are several surgical procedures that are possible for rotator cuff treatment. The three most common procedures are:
- Open Repair
Prior to the use of the arthroscope, all rotator cuffs were repaired by looking directly at the torn tendon, through an incision about 6-10 centimeters in length. The advantage is the rotator cuff tendons are easily seen by this method, but the incision is large, and the recovery can be longer and more painful. - Mini-Open Repair
The mini-open method of repairing a rotator cuff involves both the use of an arthroscope, and a short incision to get access to torn tendon. By using the arthroscope, the surgeon can also look into the shoulder joint to clean out any damaged tissue or bone spurs. The incision is about 3-4 cm, and the recovery is somewhat less involved than the open cuff repair. - Arthroscopic Repair
An arthroscopic repair is done with small incisions, and the repair is done by the surgeon looking through a small camera to watch his or her repair on a television monitor. This is a more recent development in treatment of rotator cuff tears, and not all types of tears can be treated by this method. Some advantages and disadvantages of this procedure are discussed in the article comparing arthroscopic rotator cuff repairs to open methods.
How long is the recovery from rotator cuff repair surgery?
This will depend on several factors, including your level of strength before the operation and the severity of the rotator cuff tear. Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted. After one to two weeks, physical therapy begins. Initially, the therapy is gentle so as not to affect the rotator cuff repair. After four to six weeks, more active lifting with the arm begins. Several months after the rotator cuff repair, physical therapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.
Sources:
Gartsman, G. "Arthroscopic management of rotator cuff disease" J Am. Acad. Ortho. Surg 1998 Jul-Aug;6(4):259-66.
Iannotti, JP "Full-Thickness Rotator Cuff Tears" J Am. Acad. Ortho. Surg., Mar 1994; 2: 87 - 95.
