How Are Rotator Cuff Problems Treated?

The body needs blood to heal itself, but there are few blood vessels to supply the rotator cuff with blood. Because of this, most rotator cuff injuries heal slowly. The most serious type of rotator cuff injury, a completely torn tendon, usually requires surgery in order to heal completely.

Treatment of rotator cuff problems depends on the nature and extent of the injury. Most people, including those who have a partially torn tendon, can be treated without surgery. Even those who have a completely torn rotator cuff can sometimes regain enough strength and flexibility to function without surgery.

Rotator cuff problems can be treated with:

• Nonsurgical treatments

• Surgery

Nonsurgical Treatments

Nonsurgical treatments of rotator cuff injuries include:

• Rest. The first step in treating any rotator cuff problem is to rest the injured joint until the pain and swelling subside.

• Ice. In the first 24 hours after an injury, ice can help reduce pain and swelling.

• Heat. After 24 hours have passed, a heating pad or hot compress can help an injured rotator cuff to heal.

• NSAIDS (non-steroidal anti-inflammatory drugs). NSAIDS such as aspirin and ibuprofen can reduce both pain and swelling. Be careful to take NSAIDS as instructed, since they sometimes can produce stomach upset and gastrointestinal problems.

• Physical therapy/exercise. Many rotator cuff problems can be successfully treated with gentle exercises designed to stretch and strengthen the shoulder muscles. Usually, it's best to begin physical therapy as soon after an injury as is possible. Avoid lifting heavy weights overhead, and avoid activities such as throwing a baseball that put a significant amount of stress on the tendons.

• Steroids. Steroids such as cortisone may be used to reduce inflammation. Steroids can be taken orally, but for rotator cuff problems they are usually injected directly into the area around the tendon. Steroid injection should be used carefully and multiple injections should be avoided.

Surgery

Surgical repair of a completely torn rotator cuff repair may be performed as "open" surgery, requiring a two- to three-inch incision in the shoulder.

It is, however, becoming more common for surgeons to perform arthroscopic surgery, in which a video camera and surgical instruments are inserted through a small incision about the size of a buttonhole. Surgeons sometimes use a combination of arthroscopic and open surgical techniques.

Rotator cuff surgery can be performed under general anesthesia (with the patient asleep) or regional anesthesia (with the patient awake.)