From the Guidelines
The initial management for rotator cuff syndrome should focus on nonsurgical treatment using exercise and/or NSAIDs, as this approach has been shown to decrease pain and improve function in patients without a full-thickness tear. When managing rotator cuff syndrome, it is essential to consider the absence of a full-thickness tear, as this significantly influences the treatment approach. According to a study published in The Journal of the American Academy of Orthopaedic Surgeons 1, patients with rotator cuff–related symptoms in the absence of a full-thickness tear should be initially treated nonsurgically. This recommendation is based on several level II studies that report the beneficial effects of exercise in decreasing pain and improving function in such patients.
Some key points to consider in the initial management include:
- Exercise programs that have been shown to significantly improve pain scores and function in patients with rotator cuff–related symptoms without a full-thickness tear 1.
- The use of NSAIDs for pain management, which can be an effective adjunct to exercise therapy.
- The importance of avoiding activities that exacerbate symptoms while maintaining gentle range of motion exercises to prevent stiffness and promote healing.
- Considering alternative pain management options, such as acetaminophen, for patients who cannot take NSAIDs.
By prioritizing nonsurgical management with exercise and/or NSAIDs, patients with rotator cuff syndrome can potentially achieve significant improvements in pain and function, thereby enhancing their quality of life and reducing the risk of morbidity and mortality associated with more invasive treatments.
From the Research
Initial Management for Rotator Cuff Syndrome
The initial management for rotator cuff syndrome typically involves conservative treatment options. Some of the key approaches include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation 2
- Corticosteroid injections to decrease inflammation and relieve pain 2, 3
- Functional rehabilitation therapy, including physical therapy, to improve range of motion, strength, and function 2, 3
- Rest, ice packs, and modification of activities to avoid exacerbating the condition 3
Role of Physical Therapy
Physical therapy plays a crucial role in the management of rotator cuff syndrome. Studies have shown that:
- Progressive exercise compared to best-practice advice may not result in significant differences in shoulder pain and function over 12 months 4
- Physical therapist interventions alone may be as effective as corticosteroid injections in improving pain and function, especially in the long term 5, 4
- A combination of corticosteroid injection and physical therapist interventions may provide some short-term benefits in pain and function 5, 4
Considerations for Treatment
When considering treatment options for rotator cuff syndrome, it is essential to:
- Assess the extent of disease and patient symptoms to determine the most appropriate treatment approach 6
- Consider the potential benefits and risks of corticosteroid injections, including the risk of adverse events 5, 4
- Establish a treatment plan that includes a combination of conservative management options, such as physical therapy, NSAIDs, and corticosteroid injections, as needed 2, 3, 6