From the Guidelines
Treatment for a rotator cuff injury should prioritize conservative measures, including rest, ice application, and over-the-counter pain medications, with surgical repair considered only if conservative treatment fails or if imaging shows a complete tear, as recommended by the most recent and highest quality study 1.
Overview of Treatment Approach
The approach to treating rotator cuff injuries involves a combination of non-surgical and surgical methods, with the goal of reducing pain, improving function, and enhancing quality of life.
Non-Surgical Treatment
Non-surgical treatment typically includes:
- Rest, ice application for 15-20 minutes several times daily
- Over-the-counter pain medications such as ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to reduce inflammation and pain
- Physical therapy focusing on gentle stretching and strengthening exercises for the shoulder muscles, typically performed 3-5 times weekly for 6-12 weeks
- For moderate pain, a healthcare provider might prescribe stronger medications or administer a corticosteroid injection into the shoulder joint
- Using a sling for brief periods can help rest the shoulder, but prolonged immobilization should be avoided as it may lead to stiffness
Surgical Treatment
Surgical repair may be necessary if conservative treatment fails after 3-6 months or if imaging shows a complete tear. The most recent guideline recommends an arthroscopic approach for rotator cuff repair whenever possible, as it is associated with reduced postoperative pain 1.
Postoperative Pain Management
For postoperative pain management, the guideline suggests:
- Systemic analgesia including paracetamol and non-steroidal anti-inflammatory drugs (NSAID) administered pre-operatively or intra-operatively and continued postoperatively
- Interscalene brachial plexus blockade as the first-choice regional analgesic technique
- A single dose of intravenous (i.v.) dexamethasone to increase the analgesic duration of interscalene brachial plexus block, decrease analgesic use, and provide anti-emetic effects
- Opioids should be reserved as rescue analgesia in the postoperative period
Recovery and Rehabilitation
Recovery time varies from weeks to months depending on injury severity. Rehabilitation after surgical repair is crucial for restoring shoulder function and stability. The treatments work by reducing inflammation, strengthening supporting muscles, and in severe cases, directly repairing damaged tendon tissue.
Given the most recent and highest quality evidence, the recommendation for treating rotator cuff injuries prioritizes conservative management, with surgical intervention based on specific criteria, such as failure of conservative treatment or presence of a complete tear, as supported by 1.
From the Research
Treatment Options for Rotator Cuff Injury
- Conservative management is a recommended initial treatment approach for rotator cuff injuries, including partial thickness rotator cuff tears (PT-RCTs) 2, 3, 4, 5.
- Pharmacologic treatment options include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, with ibuprofen showing improvement in pain severity and functional activity 6.
- Physical therapy protocols, including eccentric rehabilitation, have demonstrated improvements in pain and strength 2, 3, 5.
- Injections such as platelet-rich plasma (PRP), collagen, hyaluronic acid (HA), and corticosteroids have shown favorable outcomes in terms of pain reduction and functional recovery 2.
Comparison of Treatment Approaches
- A systematic review found that conservative management of PT-RCTs, involving physical therapy, PRP injections, and other injections, demonstrates favorable clinical outcomes 2.
- A meta-analysis found that surgery is not more effective in treating rotator cuff tear than conservative treatment alone, with no clinically significant difference in improving Constant score or reducing pain 4.
- Conservative treatment has been shown to be effective in reducing pain and improving function, with a successful rate varying widely from 33 to 92% 5.