From the Guidelines
The treatment approach for rotator cuff tear with weakness versus rotator cuff tendinopathy without weakness should prioritize conservative management for tendinopathy, as evidenced by the beneficial effects of exercise in decreasing pain and improving function, as reported in several level II studies 1. The key difference in treatment approach lies in the presence or absence of a full-thickness tear and associated weakness. For rotator cuff tears with weakness, surgical intervention may be considered, particularly for complete tears or in younger, active patients. However, for rotator cuff tendinopathy without weakness, a conservative approach is recommended, involving:
- Exercise and/or NSAIDs as initial treatment, as suggested by the Journal of the American Academy of Orthopaedic Surgeons 1
- A structured rehabilitation program focusing on eccentric strengthening exercises and scapular stabilization
- Possible corticosteroid injections for pain relief The conservative approach for tendinopathy is supported by studies showing significant improvements in pain and function with exercise programs, such as the study reporting improved pain scores on the visual analog scale (VAS) after 8 weeks of treatment 1. In contrast, rotator cuff tears with weakness may require surgical intervention to reattach the torn tendon to the humeral head, followed by a structured rehabilitation program. The treatment timeline and management strategy differ significantly between the two conditions, with conservative management being the primary approach for tendinopathy without weakness.
From the Research
Difference in Treatment Approach
The treatment approach for rotator cuff tear with weakness versus rotator cuff tendinopathy without weakness differs in several ways:
- Rotator cuff tears with weakness often require a more aggressive treatment approach, including surgical intervention, to restore strength and function to the shoulder joint 2, 3.
- Rotator cuff tendinopathy without weakness, on the other hand, can often be treated with conservative management, including physical therapy, pain management, and injections, such as platelet-rich plasma (PRP) injections 4, 5.
- The goal of treatment for rotator cuff tendinopathy without weakness is to reduce pain and improve function, rather than to address a specific tear or weakness 5.
- In cases where rotator cuff tendinopathy is treated with PRP injections, studies have shown significant improvements in pain and function, with good to excellent early results 5.
Treatment Options
Some treatment options for rotator cuff tear and tendinopathy include:
- Physical therapy to improve strength and function
- Pain management, including medication and injections
- PRP injections to promote healing and reduce inflammation
- Surgical intervention, including arthroscopic repair, to address tears and restore strength and function
- Conservative management, including relative rest and modification of activities, to allow the tendon to heal
Considerations for Treatment
When considering treatment for rotator cuff tear or tendinopathy, several factors should be taken into account, including: