Rotator Cuff Tear Treatment Options
Treatment depends on the type of tear, the patient’s age, activity level, and general health. For traumatic complete tears in patients, surgical treatment is generally recommended followed by appropriate rehabilitation. The goal of treatment is to reduce pain and improve function. If you have chronic pain and dysfunction early treatment can reduce the risk of worsening your condition.
About 80% of patients achieve pain relief and improved function with nonsurgical management.
Nonsurgical management includes:
- Activity modification
- NSAIDS help with pain and swelling
- Strengthening exercises and physical therapy will restore movement, improve flexibility and range of motion. Stronger muscles will help support the shoulder and relieve pain, as well as prevent future pain.
- Steroid injections may be offered if rest, medication, and therapy don’t relieve pain. Steroid injections are very effective at relieving pain but may provide only short-term pain relief and may not help some people.
Nonsurgical management is an option for some patients who can get better and live with a small tear. However, it does not heal the tear and a small tear may progress in size and symptoms requiring continued activity limitations. Still, nonsurgical management may improve symptoms, strength, and function. It is well established that full thickness tears do not heal without surgical intervention.
What are the indications for surgical intervention?
- Recent acute injury caused a rotator cuff tear
- Chronic symptoms or degenerative tears
- When symptoms do not improve with three months of nonsurgical management
- There is a complete tear (over 3 cm) with surrounding healthy tissue
- Significant weakness or loss of shoulder function
What are the surgical options?
- Rotator Cuff Repair
- A partial tear may need only trimming called debridement.
- Often, other structures in the shoulder are damaged and require additional procedures including distal clavicle excision, subacromial decompression, labral debridement, and biceps tenodesis.
The type of repair depends on size of tear, your anatomy and quality of your tendon tissue and bone. If there are other shoulder injuries, they will be repaired at the same time. Most types of repair surgery can be accomplished as an outpatient.
- Arthroscopic repair uses a small camera, small incisions, and guided instruments. It can be done as an outpatient. This approach reattaches tendon to bone, restores anatomy, removes bone spurs, and smooths the damaged tendon.
- Arthroscopic debridement and decompression is designed to remove loose pieces of tendon and other debris to allow the rotator cuff to move smoothly.
- A mini-open surgery is the gold standard that includes arthroscopy and minimally open surgery. It uses arthroscopy to assess and treat damage to the joint including bone spurs. After the other damage is fixed, repair to the rotator cuff is accomplished through a small incision without the arthroscope.
- Open surgery is less common but may be indicated for large, complex tears; when there is additional shoulder damage; and when revision surgery or a tissue graft is required. During open surgery a portion of the deltoid muscle is split to access tendon. Then, the surgeon will remove bone spurs, and loose tendon fibers and conduct other repairs as needed. Some tears can be sewn together and then repaired back to the top of the upper arm bone. Large tears may require complex reconstruction or tendon transfer and require a longer recovery time.
- Tendon transfer may be needed where the torn tendon is so damaged that it can’t be reattached. A nearby tendon may be used as the replacement.
- Reverse shoulder replacement is the procedure for massive cuff injuries that cannot be repaired. Here the rotator cuff muscles no longer function correctly and are too damaged or atrophied to be repaired. Since there is no cuff to support the arm and provide function, the surgeon will use the deltoid muscle instead, to provide strength and power to move the shoulder joint.
- Harrison may offer biologic augmentation with platelet-rich plasma during surgery to reduce the risk of repair failure after rotator cuff repair regardless of tear size.
After surgery your arm will be in a sling which will protect the shoulder and for the first month to six weeks arm movement will be restricted and your pain will be managed with medication. Then you will begin rehabilitation to restore your function and strength.
Complete recovery takes months. Improved function, range of motion and strength will take at least 4-6 months. Patients must be committed to rehabilitation to achieve a satisfactory result.
All of these surgical techniques provide similar results: pain relief, improved strength and function, and patient satisfaction. Surgical expertise is necessary to achieve satisfactory results.
Your rotator cuff plays an essential role in the function of your shoulder. Dr. Harrison has been in practice for over 24 years treating thousands of patients from all walks of life including high school, college, Olympic, and professional athletes. When you injure your rotator cuff, contact Dr. Harrison to schedule a consultation.
Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team and the Head Team Physician for Weber State University for over 20 plus years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center. He finished his formal training with an additional AO Trauma Fellowship in Bern, Switzerland.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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