If you have a rotator cuff tear, what is your best option for treatment?
If you have a documented full thickness tear of your Rotator cuff, and have weakness and pain, surgical repair may indeed be your best option. Even amongst those with aymptomatic tears, 30% will become painful within 3 years----and by then functional outcome may be impaired by atrophy and fatty infiltration of the muscle. That having been said, small tears may be painful, but unaccompanied by weakness. In these cases, there is little downside to tryiing nonoperative treatment, including a cortisone shot and PT(physical therapy). When trapezial discomfort or a cervical basis for pain persist, when there is no weakness, and when one prefers to avoid surgery---at least for a few months, in the hope that pain will settle down, chiropractic care and massage may be helpfull. As one might imagine, each situation may be different-----bottom line---a cuff tear based on mri or suspicion due to weakness on exam, merits assessment by a shoulder specialist to point you in the right direction and to assist you in choosing the most appropriate option.
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2 comments
nickc 3/15/10 at 12:41 pm
If I do require a rotator cuff repair, how long will I need to be in a sling, and does that time differ if I am fixed through a small incision as opposed to an arthroscopic repair?
mtomaino 3/15/10 at 12:48 pm
Nick,
The biology of tendon healing to bone, and the loads accompanying "active" shoulder motion, necessitate a 6 week period in a sling if a cuff repair is performed--regardless of the technique (open versus arthroscopic). However, unless a large or massive repair is required, in which case I will not begin passive range of motion in PT for 6 weeks, we usually start PT after your 1st postop appointment at 6 days. During the initial 6 weeks after repair, the physical therapist will see you 1-2 times a week for "passive" exercisies to prevent a frozen shoulder from developing. That having been said--a little stiffness at 12 weeks with a "healed repair" is better than great early motion, but a "failed repair" because of too much strain on the tendon-bone interface before heaing had occurred.