Non-Surgical Treatment of Rotator Cuff Tears

The rotator cuff is a group of tendons and muscles that move the shoulder joint. Tears can occur in any of those tendons. The tear may be caused by trauma or degenerative changes. Traumatic tears occur in young people while older people typically have degenerative tears. Degenerative tears are often referred to as degenerative cuff disease. A tear can potentially cause pain and impair arm function.

Studies report patient with rotator cuff tears, whether they are degenerative or traumatic, can improve with non-surgical treatment. Surgery is usually considered only after all non-surgical treatments have failed. Surgical intervention may be recommended initially in some patients like high-demand athletes, those with demanding jobs/lifestyles, and individuals who have such severe damage to the cuff that they must have surgery to restore shoulder mechanics.

What are degenerative tears?

Degenerative tears result from normal wear and tear, bone spurs, overuse and poor blood supply to the rotator cuff. As we age our tendons fray and may eventually tear, but the tendons remain attached to the bone. Rotator cuff disease can be bilateral, meaning if a patient has a tear in one shoulder, there could also be a tear on the contralateral side, however that is not usually the case.

Degenerative rotator cuff tears are the most common cause of shoulder pain and disability and in the aging population. Yet, studies report that about 20% of patients in their 60s and 80% of patients in their 80s have rotator cuff tears with no symptoms. Non-surgical management of cuff tears can be successful and is a well-accepted treatment for atraumatic full thickness tears in the short term.

What is a full thickness tear?

A full thickness tear is one where the tendon is torn completely off the bone. It is also called a complete tear. These tears are a frequent source of pain and dysfunction. Studies report that full thickness tears affect about 25% of individuals in their sixties, and more than 50% of those in their eighties.

What is non-surgical management of rotator cuff tears?

Rest, ice and physical therapy, activity modification, over the counter pain medications, and strength training are the key elements of non-surgical management. Patients who have pain during rest, that does not improve with medication and therapy, may need steroid injection therapy. Without proper care, shoulder pain can worsen.

When is conservative non-surgical management an option?

In patients with significant medically comorbid diseases or advanced age, conservative management is the preferred treatment. For younger patients with full thickness tears the choice of treatment will depend upon the likelihood that the tear will progress. Sometimes delaying surgery in high-risk tears can allow the tear to enlarge or the patient can develop irreversible muscle changes that when combined with age will interfere with successful tendon healing.

Your consultation with Dr. Johnston

During your consultation with Dr. Johnston, he will ask about your symptoms, and evaluate your cuff with various tests and imaging studies. After reviewing the imaging studies, he will make a definitive diagnosis and conduct a risk assessment to determine the likelihood that your tear will progress. He will order a trial of non-surgical management and may recommend minimally invasive surgical repair.

Generally, conservative management is preferred for small and large atraumatic tears, and low-risk tears including partial thickness tears, large tears with muscle changes, degenerative tears.

Dr. Peter Johnston is a board-certified orthopedic surgeon and sports medicine doctor, who specializes in complex shoulder and elbow conditions. He received a Fellowship in complex shoulder and elbow surgery at the TJU's Rothman Institute where he trained with world renowned shoulder and elbow surgeons. When you or a loved one has shoulder problems, contact Dr. Johnston to schedule a consultation where you will be treated with respect and compassion.