From the Guidelines
Treatment for a left rotator cuff injury should prioritize a combination of rest, pain management, physical therapy, and in some cases, surgery, with a focus on reducing morbidity, mortality, and improving quality of life. Initially, rest the shoulder and avoid activities that cause pain. Take over-the-counter pain medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily with food) for 1-2 weeks to reduce inflammation and pain, as recommended by 1. Apply ice to the affected area for 15-20 minutes every 2-3 hours during the first few days.
Key Considerations
- Physical therapy is crucial for recovery, focusing on exercises to restore range of motion, strengthen the rotator cuff muscles, and improve shoulder stability, although the evidence for its effectiveness is inconclusive 1.
- A typical program includes pendulum exercises, wall crawls, and resistance band training, performed 3-5 times weekly for 6-8 weeks.
- If conservative treatments fail after 3-6 months or if there's a complete tear, surgical repair may be necessary, with arthroscopic approach being the preferred method whenever possible, as it is associated with reduced postoperative pain 1.
- Recovery from surgery requires 4-6 months of rehabilitation.
Additional Treatment Options
- Corticosteroid injections with local anesthetic may be considered for short-term improvement in both pain and function, as supported by moderate evidence 1.
- Systemic analgesia, including paracetamol and non-steroidal anti-inflammatory drugs (NSAID), should be administered pre-operatively or intra-operatively and continued postoperatively, with opioids reserved as rescue analgesia in the postoperative period 1.
- Interscalene brachial plexus blockade is recommended as the first-choice regional analgesic technique, with suprascapular nerve block, with or without axillary nerve block, as an alternative 1.
Prioritizing Outcomes
The primary goal of treatment is to reduce morbidity, mortality, and improve quality of life, with a focus on restoring shoulder stability and preventing further injury to the rotator cuff muscles. By prioritizing these outcomes, treatment can be tailored to the individual patient's needs, with a combination of conservative and surgical approaches as necessary.
From the Research
Treatment Options for Left Rotator Cuff Injury
- Conservative treatment options for rotator cuff injuries include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 2
- Corticosteroid injections 2, 3, 4, 5
- Functional rehabilitation therapy 2, 3, 5
- Physical therapy to restore range of motion, address stiffness, and restore motor control/strength to the scapula and rotator cuff 3
- Platelet-rich plasma injections 3, 4
- Hyaluronic acid injections 4
- Surgical management is reserved for refractory cases that have exhausted conservative measures 2
- Electrotherapy modalities, such as therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF), may also be used as components of a physical therapy intervention 6
- A combination of physiotherapy and corticosteroid injection may be more effective in reducing pain and improving range of motion than either treatment alone 5
Comparison of Treatment Options
- Corticosteroid injections combined with hyaluronic acid injections may be recommended for non-surgical conservative clinical management of rotator cuff injuries 4
- Therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease 6
- The effectiveness of other electrotherapy modalities, such as TENS and PEMF, is uncertain due to very low quality evidence 6
Considerations for Treatment
- Injury prevention programs are essential for the long-term care of patients with rotator cuff disease, for primary prevention, and for prevention of recurrent injuries 2
- The choice of treatment should be based on the individual patient's needs and circumstances, and may involve a combination of conservative and surgical approaches 2, 5