Rotator cuff tears often heal with few or no long-term effects. A conservative treatment, usually consisting of physical therapy and anti-inflammatory medications, is generally tried first, and often with very good results. For specific kinds of rotator cuff tears, or for tears that do not respond to conservative treatment, surgical repair of the rotator cuff and debridement of the shoulder joint area is often necessary.
Conservative Treatment
Treatment of rotator cuff tears often consists of a long period of rest of the shoulder, sometimes lasting as long as four to nine months or more. During this time, there may be restrictions on the kind of activity that can be performed with the shoulder, but complete immobility is generally not recommended. Physicians and physical therapists often prescribe range of motion exercises in an effort to stimulate movement and repair the injured muscle and tendons. In addition, anti-inflammatory and analgesic medication can help speed recovery by reducing the pain and inflammation that occur with a rotator cuff tear.
Surgical Intervention
In acute injuries or injuries that do not respond well to conservative treatment, surgical intervention is often used in order to repair the rotator cuff and clear out any debris that resulted from the initial injury. Arthroscopic surgery is most commonly used, and yields the best results in terms of recovery time and restoration of function. Even after arthroscopic surgery, a period of rehabilitation with strengthening exercises and activities to increase shoulder range of motion is prescribed. For some kinds of rotator cuff tears, surgery is the first choice, especially in major injuries or in specific types of incomplete tears of the rotator cuff.
Chronic Injuries
Chronic rotator cuff injuries present special challenges to both patients and health care providers. Sometimes a chronic rotator cuff tear begins with a small injury, which causes inflammation of the sacks which lubricate the shoulder joint (bursitis). With repeated injury, this may progress to inflammation of the tendon component of the rotator cuff (rotator cuff tendonitis), and eventually to a tear in the rotator cuff itself, which is associated with pain, decreased range of motion of the shoulder and arm, and resulting weakness and withering away of the shoulder muscle. Chronic rotator cuff tears often respond to treatment, and so a thorough evaluation and assessment by an orthopaedic surgeon is recommended for anyone who has experienced long-term shoulder pain and decreasing range of motion in the shoulder. Sometimes, the muscle of the shoulder with a rotator cuff injury may appear smaller than the shoulder with no injury, even before weakness is noted by the patient.
Age Considerations
Research has generally shown similar rates of recovery among those both older and younger than 60 years old who suffer from similar kinds of rotator cuff tears. Because rotator cuff tears are most common in patients older than 40 years old, age alone is generally not an indicator of the long-term effects of a rotator cuff tear. So people of any age who have shoulder pain with limited mobility that does not respond to conservative approaches like physical therapy and anti-inflammatory medications, should see an orthopedist for proper evaluation and treatment of their problems.
References
- "Current Diagnosis & Treatment in Orthopedics;" Harry B. Skinner, M.D., Ph.D., ed.; 2006
- "Orthopaedic Examination, Evaluation, and Intervention;" Mark Dutton; 2008
- NIH.gov: Arthroscopic rotator cuff repair in patients older than 60 years
