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In the acute phase, all tears should be managed conservatively:
nonoperative management includes:
- avoidance of activities that initiate
- a range-of-motion program
- nonsteroidal antiinflammatory
medication if not contraindicated
- occasional corticosteroid injections
physical modalities - initial cold treatment then graduating to heat treatment
After about three weeks, it should be possible to distinguish
a partial and a complete tear. Surgery is then indicated for large tears and for
acute rupture in a young patient, although reconstruction is not always successful.
Surgical intervention may be undertaken arthroscopically.
If surgical treatment
is not undertaken then, as the pain associated with the rotator cuff tear decreases,
a graduated strengthening program is employed - this program emphasises scapular
stabilising exercises and withholding deltoid strengthening until the shoulder
is totally painless.
- about 50% of patients will be satisfied with nonoperative
treatment - there is a significant decrease in pain and range of motion increased
in these patients; however, strength remains unchanged from the initial assessment
If surgical treatment is undertaken then post-operatively, the
arm should be put in a sling and allowed to rest at the side of the body. Gentle
pendulum motions should be started within the first week with small or medium
tears, but not until the second week in the case of a large tear. Unnecessary
strain should be avoided:
- when reaching for an object, flex the elbow
and take a step forwards rather than using an outstretched arm
the "flying elbow" when using the shoulder - ie. the arm at 90 degrees
with the humeral head impinged under the acromial arch
A well motivated
patient may expect to resume normal activity by 6 months.
poor prognosis is for nonoperative treatment includes:
- a long history
of pain (6-12 months) before their initial examination
- larger tears (>3
cm) are associated with a poorer prognosis for nonoperative treatment
severe weakness on initial presentation - only approximately 13% of patients with
severe weakness on initial examination showed a satisfactory end result with nonoperative
- pain relief is expected in approximately 50% with
nonoperative management. Following surgical repair 85% of patients have relief
of pain with restoration of some degree of strength
- surgical repair has
shown that it can improve, if not restore, strength in patients - allthough this
has not been shown for nonoperative therapy
- surgical repair has been shown
to have a higher rate of success for both pain relief and return of strength as
opposed to nonoperative treatment.
- there is evidence that suggests,
in an acute tear of less than 3 weeks in duration, early repair may provide a
better functional result
- in older patients with limited goals and a limited
lifespan then nonoperative treatment may be an effective treatment option
of partial rotator cuff tears is controversial (2)
- each partial rotator
cuff tear must be individually evaluated to determine if indeed the tear is actually
the source of clinical symptoms
- with the ability to grossly measure tear
depth arthroscopically, the goal of restoring integrity to the rotator cuff in
the younger, higher-demand patient becomes more compelling
C, Nottage WN. Surgical and nonsurgical management of rotator cuff tears. Arthroscopy
2002;18 (5): 527-531.
- Stetson WB et al. Arthroscopic treatment of
partial rotator cuff tears. Operative Techniques in Sports Medicine 2004; 12(2):135-148.
Last reviewed 01/2018