From the Guidelines

Treatment options for a rotator cuff (RC) tear include surgical repair, non-operative treatment, and a combination of both.

Arthroscopic approach is recommended as the first line of treatment for rotator cuff repair, as it is associated with reduced postoperative pain 1.
Regional analgesic techniques, such as interscalene brachial plexus blockade or suprascapular nerve block, are recommended for postoperative pain management 1.
Systemic analgesia, including paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), should be administered pre-operatively or intra-operatively and continued postoperatively 1.
Dexamethasone is recommended as a single dose of intravenous (i.v.) for its ability to increase the analgesic duration of interscalene brachial plexus block, decrease analgesic use, and anti-emetic effects 1.

Physiotherapy is a viable option for non-operative treatment, with some studies showing no clinically important differences between physiotherapy and surgical repair at short-term and long-term follow-up 1.
Non-operative treatment may include exercises, glucocorticoid injection, and other conservative management strategies 1.

A multimodal analgesia approach is preferred, combining surgical repair with non-operative treatment strategies, such as physiotherapy and pain management 1. It's essential to note that the evidence for the effectiveness of arthroscopic rotator cuff repair is moderate to low, and some studies have shown little or no clinically important benefits compared to non-operative treatment 1. Therefore, the treatment approach should be individualized, taking into account the patient's specific condition, preferences, and needs.

From the Research

The treatment options for rotator cuff (RC) tears can be broadly categorized into nonoperative and operative management.

Nonoperative management includes:
- Physical therapy to restore range of motion, address stiffness, and improve motor control and strength of the scapula and rotator cuff 2
- Injections such as corticosteroids, hyaluronate, and platelet-rich plasma 2, 3
- Nonsteroidal anti-inflammatory drugs 2
Operative management includes:
- Arthroscopic debridement with a biceps tenotomy or tenodesis 4
- Complete or partial repair 4
- Patch augmentation 4
- Superior capsular reconstruction 4
- Muscle/tendon transfer 4
- Reverse total shoulder arthroplasty 4
- Decompression, a less invasive surgical option that provides short-term pain relief 3

The selection of treatment depends on various factors, including symptoms, tear size, and patient characteristics.

For patients with massive rotator cuff tears, the treatment options are more complex and may involve a combination of the above-mentioned operative management techniques 4
In elderly patients, treatment options can be broadly divided into nonsurgical and surgical, with the majority of patients initially placed on a trial of conservative therapy 3
Predictors of poor outcome after repair include large tear size and higher stages of fatty infiltration 3

The outcomes of treatment for rotator cuff tears vary depending on the treatment modality and patient characteristics.

A systematic review with meta-analysis found that repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6,12, and 24 months, although the clinical relevance of these effects was limited 5
Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients 6