Rotator Cuff Disorders: Treatment Overview

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Treatment Overview

Treatment for rotator cuff disorders focuses on relieving pain and inflammation and restoring shoulder strength, flexibility, and function. Treatment may help to prevent further complications, such as loss of strength and movement in the shoulder or additional degeneration or tearing. Treatment considerations include your symptoms, age, activity level, and whether your symptoms appear to be related to a rotator cuff injury. You and your health professional will decide together which treatment is best for you.

Nonsurgical treatment

Most rotator cuff disorders are treated without surgery. Your treatment may include:

• Resting, although gentle movement of the shoulder is recommended. Prolonged immobilization (holding the shoulder still), such as with slings or braces, may cause the shoulder joint to become stiff or even lead to frozen shoulder.
• Applying cold or heat, whichever helps more.
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs).
• Avoiding positions and activities that hurt your shoulder. Usually, these are overhead positions and activities.
• Strengthening your other shoulder muscles.
• Physical therapy, usually involving exercises to stretch and gradually strengthen the shoulder. Physical therapy can reduce pain in the soft tissues (muscles, ligaments, and tendons), improve function, and build muscle strength. A physical therapist may provide these treatments and will also provide education, instruction, and support for recovery.

Most people with tendinitis or bursitis recover without surgery. If symptoms do not improve after a few months of nonsurgical treatment, you and your health professional may consider testing (such as X-rays or magnetic resonance imaging) to find out if you have a rotator cuff tear. Your health professional may consider a corticosteroid injection if a severely inflamed tendon or bursa does not respond to other nonsurgical treatment.

Surgery

Surgery is most useful in relieving pain and weakness in the shoulder or if the tendons are being squeezed as they move through their normal ranges of motion. The two types of surgery for rotator cuff disorders are subacromial smoothing and rotator cuff repair.

Surgery typically is used to repair a torn rotator cuff in a healthy young person, because good results are more likely if there is little or no evidence of degeneration or impingement. People with advanced rotator cuff disorders and tendons that are tough, stringy (fibrous), and stiff usually respond less well to surgery. Surgery may successfully repair the tear, but it cannot repair all the damage caused by age or degeneration. But surgery may be considered for people who have:¹

• A rotator cuff tear caused by a sudden injury. In these cases, it's best to do surgery within a few months of the injury.
• Symptoms that do not respond well to 3 to 6 months of nonsurgical treatment. These symptoms might include:
  • Severe pain.
  • Loss of shoulder strength and movement.

Should I have rotator cuff surgery?

What To Think About

Treatment of rotator cuff disorders should begin soon after an injury or symptoms develop, to give you the best chance of restoring flexibility and strength to your shoulder. Without treatment, a cycle of inflammation, tearing of tendons, and scar formation may develop, resulting in pain, decreased tendon strength, and loss of function.

Recovery from a rotator cuff disorder varies with each individual. Your physical therapy and home exercise program should continue until your shoulder is as strong and flexible as possible. Some treatments for rotator cuff disorders can last up to a year. Most people can return to their previous activities after several weeks of rehabilitation.

Health professionals have differing opinions about treating rotator cuff tears. Nonsurgical treatment is preferred by some health professionals to treat people older than 60. But other health professionals believe the sooner a rotator cuff tear is surgically repaired, the better the chance of a successful outcome, regardless of age.

Last updated:	February 08, 2008
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	William M. Green, MD - Emergency Medicine, Patrick J. McMahon, MD - Orthopedics
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC