From the Guidelines
For rotator cuff tendinopathy and labral fraying, the recommended treatment approach is conservative management, focusing on pain relief and rehabilitation, as it has been shown to be effective in decreasing pain and improving function in patients without a full-thickness tear 1. The treatment options for rotator cuff tendinopathy and labral fraying include:
- Rest and activity modification to avoid aggravating movements
- Ice or heat therapy for pain relief
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800 mg three times daily) or naproxen (250-500 mg twice daily) for 2-4 weeks, as suggested by the 2019 guideline for rotator cuff repair surgery 1
- Physical therapy for 6-12 weeks, including:
- Stretching exercises
- Strengthening exercises for rotator cuff and scapular muscles
- Posture correction
- Corticosteroid injection (e.g., methylprednisolone 40 mg with lidocaine) if pain persists after 4-6 weeks of conservative treatment It is essential to start with daily exercises and gradually increase intensity, avoiding overhead activities and heavy lifting during the initial healing phase. If symptoms don't improve after 3-6 months of conservative treatment, consider imaging studies (MRI) and possible surgical consultation. The use of NSAIDs and physical therapy has been supported by multiple studies, including a 2011 study that reported significant improvements in pain scores and function in patients with rotator cuff-related symptoms without a full-thickness tear 1. Additionally, a 2019 study recommended the use of systemic analgesia, including paracetamol and NSAIDs, as well as regional analgesic techniques, such as interscalene brachial plexus blockade, for postoperative pain management in rotator cuff repair surgery 1. However, it is crucial to prioritize conservative management and reserve surgical options for cases where conservative treatment has failed, as the 2011 study suggests that patients with rotator cuff-related symptoms in the absence of a full-thickness tear should be initially treated nonsurgically using exercise and/or NSAIDs 1.
From the Research
Treatment Options for Rotator Cuff Tendinopathy
- Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term 2
- Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders 2
- A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy 3
- Resistance exercise is the first-line recommended intervention for rotator cuff tendinopathy, with proposed causal mechanisms consisting of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors 4
- Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in patients with rotator cuff calcific tendinopathy 5
Treatment Options for Labral Fraying
- Arthroscopic repair of both rotator cuff and labral lesions can restore range of motion and stability and provide good clinical results in patients with combined injuries 6
- Significant improvements in forward flexion, external rotation, and internal rotation can be observed after arthroscopic treatment of both lesions 6
- A high degree of patient satisfaction and return to preinjury level of athletics can be achieved with arthroscopic treatment of both rotator cuff and labral lesions 6
Combined Treatment Options for Rotator Cuff Tendinopathy and Labral Fraying
- Arthroscopic repair of both rotator cuff and labral lesions can be an effective treatment option for patients with combined injuries 6
- A comprehensive treatment plan should include a combination of conservative management options, such as physical therapy and pain management, and surgical intervention, such as arthroscopic repair, as needed 2, 6