Rotator Cuff Injuries Treatment & Management

Updated: Feb 12, 2016
  • Author: Eileen C Quintana, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Prehospital Care

Stabilization with a shoulder sling and an ice pack are sufficient for prehospital care.


Emergency Department Care

Conservatively treat patients with chronic injuries that have progressed to a rotator cuff tear. The goals are to reduce inflammation, relieve stress on the rotator cuff, and correct any biomechanical dysfunction.

Nonoperative therapy consists of rest and activity modification, shoulder sling, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and a basic shoulder-strengthening program. [3] If NSAIDs alone do not provide adequate pain relief, consider adding acetaminophen to the treatment regimen. [4]  Various studies indicate a heterogeneous success rate ranging from 33-90%. Steroid injections can reduce pain, but there is no apparent improvement in function.

Schedule follow-up treatment as soon as possible; if the patient has not improved by a 6-week assessment, consider surgical therapy. Surgical therapy is indicated in patients younger than 60 years with a full-thickness tear demonstrated clinically or arthrographically, in patients who fail to improve after 6 weeks of rehabilitation, or in patients performing activity that requires shoulder use. Emergent orthopedic evaluation is warranted in acute injuries or even severe extension of chronic rotator cuff injuries because they have a poor prognosis if conservative modalities are used.

The success rate of surgical therapy is reported to be 77-86%. [18, 19]  Findings generally suggest that early treatment precipitates a better outcome than late treatment. Current studies find that arthroscopic repair is fully comparable with the open surgical technique. [18, 20]

Functional status needs to be determined before considering any surgical intervention. Many studies have concluded that the need for surgery should consider not only age but also type of tear, duration of symptoms, and the patient's ability to comply with the rehabilitation regimen. [21, 22, 23]

In a study of 196 adult patients with full-thickness rotator cuff tears (112 underwent surgical intervention, and 84 nonoperative management), patient characteristics predictive of surgical treatment included younger age, lower body mass index (BMI), and duration of symptoms less than 1 year. Increasing age, higher BMI, and duration of symptoms longer than 1 year were predictive of nonsurgical treatment. [24]

In a study of rotator cuff tears in patients younger than 40 years (mean, 28 years; range  16-40 years), most patients typically had a full-thickness tear with an acute traumatic etiology and responded well to both arthroscopic and open rotator cuff repair in terms of pain relief and self-reported outcomes postoperatively. These patients reported high levels of satisfaction and return to preinjury level of play. However, a subgroup of elite throwers  with partial-thickness tears from chronic overuse had improved outcomes but suboptimal return to play. [25]



Consider an orthopedic consultation in primarily acute injuries or even severe extension of chronic rotator cuff injuries. An orthopedic consultation for possible surgical intervention is required under the following conditions:

  • In patients younger than 60 years
  • For full-thickness tear demonstrated clinically or arthrographically
  • For failure to improve after 6 weeks of rehabilitation
  • If the patient's employment requires shoulder use