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Treatment of Rotator Cuff Problems

Rotator cuff tendinosis (wear and tear without a full thickness tear) is sometimes called rotator cuff tendinitis, impingement syndrome, or painful arc syndrome. The treatment of rotator cuff tendinosis involves:-

  • Activity modification and avoiding work/exercises that put excess strain on the rotator cuff
  • Occasional or short term painkillers
  • Shoulder physiotherapy
  • Possibly a small steroid injection at the site of the rotator cuff to reduce swelling and pain, and help tendon recovery and physiotherapy

The majority of patients actually improve with these simple measures alone. A small group of patients who do not get better may require surgery. The surgery (arthroscopic subacromial decompression, or arthroscopic acromioplasty) can be performed using arthroscopic ("keyhole") techniques with just two ~5mm incisions, and it involves a "cleaning up" of the inflamed and irritated tissue overlying the tendon, and also shaving off the bony spur that is often seen in the bone above the tendon. Most patients are able to go home on the same day. A sling is worn for comfort for about 1 week. Physiotherapy starts almost immediately, and the majority of patients recover most of their function by about 2 to 3 months.

Rotator cuff tears are often best managed with surgery. The surgery is performed either arthroscopically with three or four 5-mm incisions, or using an "open" incision about 5-6 cm long. Usually, smaller tears can be treated arthroscopically, but tears larger than 2-3 cm, are often better treated with an open technique. The surgery involves stitching the tendon back to its original attachment site at the top of the humerus (arm bone). The surgery can be done as "day surgery", often patients stay overnight. Because the repaired tendon still has to heal and stick to the bone, patients are required to wear a sling for about 6 to 8 weeks. Often it can take 4 to 6 months before patients return to near normal.

Some patients chose not to have their rotator cuff tears repaired. In these patients, some do in fact recover most of their shoulder function and become painfree, most likely because the other intact parts of the rotator cuff compensate for the torn part. However, there is a significant chance that the tear will continue to get larger and larger over time. The success rate of repairing "chronic" tears is much poorer than for fresh or "acute" tears. Furthermore, a small group of patients with very large untreated tears of the rotator cuff, eventually develop shoulder arthritis that might require shoulder joint replacement.

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