From the Guidelines
You should start with conservative treatment for your shoulder issues, including rest, ice, and over-the-counter anti-inflammatories, as well as physical therapy to strengthen your rotator cuff muscles. Your shoulder has several issues that need attention, including inflammation and a partial tear in your rotator cuff tendons, mild inflammation of your biceps tendon, wear and tear in your shoulder joint and labrum, and some arthritis in your AC joint. For treatment, I recommend:
- Rest from activities that cause pain
- Ice for 15-20 minutes several times daily
- Over-the-counter anti-inflammatories like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for 1-2 weeks, as suggested by 1
- Physical therapy, aiming for 2-3 sessions weekly for 6-8 weeks, focusing on gentle stretching and strengthening exercises for your rotator cuff muscles, as recommended by 1 Some key points to consider:
- Manual therapy, such as massage or joint mobilization, may be beneficial as part of a multimodal treatment plan, including exercise and education, as noted in 1
- Opioids should be reserved for severe pain that is not responsive to other treatments, and used with caution, as advised in 1
- Surgical intervention may be considered if conservative treatment is unsuccessful after 3 months, or if a full-thickness rotator cuff tear is present, as recommended in 1
- MR arthrography may be necessary to further evaluate the labral tear and determine the best course of treatment, as mentioned in your initial diagnosis. It's essential to maintain good posture and avoid overhead activities during recovery to prevent further irritation of the shoulder structures. Most rotator cuff partial tears and tendinosis respond well to conservative treatment, but complete healing may take 3-6 months. The degenerative changes noted are common with age and often respond to the same treatment approach.
From the Research
Diagnosis and Treatment Plan
- The diagnosis is moderate diffuse rotator cuff tendinosis with partial-thickness and interstitial type tear, with no retraction of the tendons 2, 3.
- The treatment plan for partial-thickness rotator cuff tears is often conservative, with surgery considered for patients who have failed non-operative measures and have persistent symptoms 2, 4.
- Conservative treatment options include platelet-rich plasma therapy, which has been shown to have positive effects on pain relief and functional improvement, although the effects may not last long-term 5.
- Surgical options include arthroscopic débridement, transosseous, in situ repair techniques, and tear completion and repair, with the choice of surgery depending on factors such as age, arm dominance, etiology, activity level, tear thickness, and tear location 3, 6.
Additional Considerations
- The presence of mild tenosynovitis of the long head of the biceps tendon and degenerative changes of the glenohumeral joint and labrum may also need to be addressed in the treatment plan 2, 3.
- Further evaluation with MR arthrography is recommended to assess the labral tear and determine the best course of treatment 3.
- The presence of mild to moderate degenerative changes and possible impingement at the level of the AC joint should also be considered in the treatment plan 4, 6.