Nonoperative Treatment

Initially, a trial of conservative treatment should be prescribed for most rotator cuff problems. Reducing or eliminating precipitating activities or changing technique in athletes can relieve pain and allow for healing. Steroid injections can help reduce inflammation and allow the patient to start an exercise program. However, these injections should be given infrequently and should not be given to patients with complete rotator cuff tears. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution and under the supervision of a physician. Exercises to reduce inflammation and restore range of motion in the shoulder should be prescribed for each patient individually. Communication between the patient and their caregivers is extremely important during any exercise program for rotator cuff disease. If symptoms persist, imaging studies as indicated above can help establish whether there is, in fact, a rotator cuff tear. Once a tear has been identified, surgical repair is generally recommended. Conservative treatment can be continued in some patients with small incomplete tears and in patients with irreparable rotator cuff.

Operative Treatment

The indication for surgical treatment is a documented partial or total rotator cuff tear that has not responded to nonsurgical treatment and produces symptoms that interfere with the patient's normal function. However, acute and symptomatic injuries in relatively young people probably need to be repaired early. Arthroscopic evaluation of the rotator cuff can be combined with surgical treatment of most injuries. Partial thickness tears less than 50% of the thickness of the rotator cuff with fraying on the inferior or superior surface can be treated by debridement of the affected portion of the tendon. Debridement allows the injured part of the rotator cuff to be refreshed and thus to stimulate a healing response. The remaining fibers hold the cuff in place for healing and a postoperative schedule should be instituted to protect the cuff during this healing phase. Certainly a patient with a more advanced partial thickness lesion, greater than or equal to 50% of the torn fibers, should undergo surgical stabilization of the rotator cuff and should be treated as if it were a rotator cuff tear in the postoperative period. rehabilitation and activities. For a superior lesion, a coracoacromial decompression procedure should also be performed, and if a coracoid impingement is identified, resection of the coracoid process should also be performed. Rehabilitation is similar to that performed after open rotator cuff repair, but the program is accelerated slightly. The rehabilitation period in these patients can be shortened because intact fibers remain to protect the integrity of the rotator cuff. The results with this method are initially very good, but the long-term results vary. During arthroscopic evaluation, the intra-articular portion of the biceps tendon should be examined for injuries associated with rotator cuff injuries. Long head debridement or tenodesis of the biceps muscle is often indicated when patients have a rotator cuff tear. At this time, labral instability and labral abnormalities can also be evaluated. Some partial thickness lesions need to be repaired to prevent progression, and repair should be considered for all small full thickness lesions. An arthroscopically assisted method has been developed for the repair of most rotator cuff tears. The same principles of repair are used in the arthroscopy-assisted method as in an open repair. Under arthroscopic visualization, the greater tuberosity in the affected tendon area opens into a bleeding bone canal. Next, using an intra-articular suturing technique, the surgeon passes the sutures through the suture anchors in the greater tuberosity and the rotator cuff is attached to the bone by tightening the suture. Side-to-side suture repair is used for larger tears.

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