Initial Management: Rotator Cuff Injury vs Adhesive Capsulitis
For rotator cuff injuries, start with physical therapy combined with NSAIDs and consider a single corticosteroid injection for short-term pain relief, while for adhesive capsulitis, prioritize multimodal rehabilitation with manual glenohumeral mobilizations, stretching exercises, and consider radial shockwave therapy or cryotherapy. 1, 2
Rotator Cuff Injury Initial Management
First-Line Conservative Treatment
- Begin supervised physical therapy immediately as strong evidence demonstrates that patient-reported outcomes improve with physical therapy in symptomatic patients with full-thickness rotator cuff tears 1
- Supervised physical therapy is superior to unsupervised home exercise for rotator cuff pathology 1
- NSAIDs and acetaminophen provide baseline pain control 3, 4
Corticosteroid Injection Strategy
- Use a single corticosteroid injection with local anesthetic for short-term improvement in both pain and function, supported by moderate evidence 1
- Avoid multiple steroid injections as consensus opinion indicates they may compromise rotator cuff integrity and affect subsequent repair attempts 1, 3
- The injection provides relief but does not alter the natural history of tear progression 1
Critical Monitoring Parameters
- Tear size, muscle atrophy, and fatty infiltration may progress over 5-10 years with nonsurgical management alone 1
- Obtain MRI, MR arthrography, or ultrasonography as adjuncts to clinical examination for identifying rotator cuff tears 1
- Older age is associated with higher failure rates and poorer outcomes after eventual repair 1
When to Consider Surgery
- Early surgical repair after acute traumatic injury is an option, particularly within 3 weeks of injury 1
- Surgery becomes appropriate when conservative measures fail in healthy surgical candidates 5, 4
- Healed rotator cuff repairs show improved patient-reported and functional outcomes compared with physical therapy alone and unhealed repairs 1
Adhesive Capsulitis Initial Management
Primary Rehabilitation Approach
- Implement multimodal rehabilitation combining manual therapy, stretching, and supervised exercises as the foundation of treatment 2
- Manual glenohumeral mobilizations using posterior approaches and high-grade mobilizations are effective 2
- Stretching is mandatory in all rehabilitation programs for adhesive capsulitis 2
Effective Physical Modalities
- Radial extracorporeal shockwave therapy (rESWT) demonstrates effectiveness for adhesive capsulitis 2
- Whole body cryotherapy (WBC) shows benefit in multimodal programs 2
- Ultrasound therapy has not proven effective and should be avoided 2
Exercise Prescription
- Both individual and group therapeutic exercises are effective when oriented toward daily activities 2
- Exercises can be supervised or home-based depending on patient capability and adherence 2
Pharmacologic Adjuncts
- Anti-inflammatory drug therapy provides symptomatic relief as part of multimodal treatment 2
- Consider corticosteroid injections for refractory pain, though evidence is less robust than for rotator cuff pathology 2
Critical Distinction When Both Conditions Coexist
Concomitant Pathology Management
- When rotator cuff tear and adhesive capsulitis occur together, address both surgically in one stage with arthroscopic capsular release, gentle manipulation under anesthesia, and rotator cuff repair 6
- This single-stage approach produces excellent outcomes with high patient satisfaction 6
- Follow with an accelerated postoperative protocol balanced with protection for healing 6
Common Pitfalls to Avoid
Rotator Cuff Injuries
- Do not delay imaging when clinical suspicion is high, as early diagnosis guides appropriate treatment timing 1
- Avoid multiple corticosteroid injections that compromise tissue integrity 1, 3
- Do not assume all shoulder pain in trauma is rotator cuff injury—consider labral tears, which require different management 7