The management of rotator cuff tears requires a very individualised approach to patient management.
Non-operative management includes pain management strategies with warm or cold packs, analgesia and anti-inflammatories and often a steroid injection to alleviate some of the pain and inflammation. A dedicated physiotherapy rehab program is vital in this aspect of the management. Rehabilitation of the other muscles of the rotator cuff rebalance the shoulder, allowing the pain and inflammation to settle, which then allows the function to return and the patient to get better. The tear does not go away, and some maintenance of rotator cuff strengthening in the longer run is advisable for general rotator cuff health.
Operative management is through a shoulder arthroscopy and rotator cuff repair, where the tendon insertion is cleaned and the tendon is then resutured down to the bone. In some cases an open repair is performed due to the tear being too big or too stuck down to mobilise properly.
Deciding who would do best with or without an operation is key and some issues need to be taken into account. The main considerations are whether the tendon tear is a cause for the pain, as many patients the same age have asymptomatic tears, and which tears will progress to become disabling for the patient in years to come.
Tears in younger patients with a definite history of an acute shoulder injury or acute shoulder dislocation usually have either an acute tear or an acute on chronic tear. These tears then need to be divided up into partial or full thickness tears, as acute full thickness rotator cuff tears need operative repair. Partial thickness tears without significant weakness may initially be managed by a trial of non-operative management, as discussed above. Partial thickness tears with significant weakness are more likely to need a repair. Generally speaking, the younger the patient the better their chance of healing if surgery is undertaken.
Chronic tears of the rotator cuff may also either be partial or full thickness. In chronic partial thickness tears the management is first a trial of non-operative management before proceeding to offering operative repair.
In full thickness tears, sometimes almost inexplicably the shoulder still has full movement, and non-operative management and continued strengthening of the rotator cuff is indicated. In chronic full thickness tears with significant weakness or shoulder dysfunction, operative repair is indicated. In some instances, the tear has progressed to such a stage that repair is impossible, and an alternative procedure is indicated.
Postoperatively it is important to go slow with rotator cuff tear surgery rehab. It takes months for the shoulder to recover its full strength and range. This is important to understand prior to surgery, as managing expectations to allow for good tendon healing prior to loading it in rehab are important to prevent a retear.