There is a wide range of potential treatment options for most rotator cuff injuries. Partial and degenerative rotator cuff injuries often respond to rest and rehabilitation. If rest, rehabilitation, and other non-invasive treatments do not work, injections may be recommended.
Surgery is typically reserved for patients with complete or high-grade tears of the rotator cuff.
Typical management of rotator cuff muscle and tendon injuries requires patients to demonstrate patience and consistent effort. This approach has three phases:
- Protection and pain-control phase
- Restorative phase, which addresses range of motion and strength deficits
- Integrative phase, which incorporates sports-specific activities
- Protection and Pain Control
The initial treatment for rotator cuff injuries involves pain control and relative rest. Adequate pain management is typically achieved with anti-inflammatory medications or cortisone injections.
The patient may need to wear a brace or sling to limit shoulder movement. Immobilization of the shoulder should be as brief as possible, even with complete tears. Immobilization for long periods can lead to further complications, such as the loss of range of motion and a painful condition called adhesive capsulitis (frozen shoulder).
- Restorative phase
Partial thickness tears and tendonitis may be treated with home therapy or formal physical therapy. Once pain and range of motion have been addressed, the therapy focuses on strengthening the rotator cuff; correcting strength and flexibility deficits or imbalances; and addressing stability and mobility issues surrounding the scapula, or shoulder blade, at the back of the shoulder (which can affect the rotator cuff).
- Integrative phase
During this stage the patient returns to normal activities by incorporating appropriate biomechanics into complex and sports-specific skills. For example, small changes in throwing or lifting motions may help prevent future symptoms and injury.
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If these initial treatments do not work, doctors may recommend other non-invasive treatments or injections.
Other non-invasive treatments
Several non-invasive treatments for rotator cuff tendon injuries are described below. These treatments are not well researched, and there is no general consensus about whether they work. While the treatments are unproven, some doctors and physical therapists believe that they are worth a try before recommending injections or surgery.
Topical nitroglycerin. This medication comes in the form of a topical patch and may help with both pain and healing by encouraging better blood flow. Nitroglycerin, often used as a heart medication, relaxes and widens blood vessels.
Ultrasound. Efforts to heal the rotator cuff and reduce pain may get a small boost from ultrasound and electrical muscle stimulation.1
Iontophoresis. This treatment uses a mild electrical current to administer an anti-inflammatory medicine (e.g. dexamethasone) through healthy skin and into the sore area.8 Iontophoresis may be appropriate for people who can't tolerate injections or want to avoid injections.
These treatments are still being researched and are considered unproven; however, some insurance companies will still cover them. As with any elective treatment, patients concerned with cost should check with their insurance providers.