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How are rotator cuff tears treated?

If you have a rotator cuff tear, you should perform a combination of flexibility and strengthening techniques to help your body heal and prevent further injury. Begin by foam rolling your pecs (chest) and latissimus dorsi (lats). Foam rolling is a form of self-massage that can help relax tight muscles before you stretch them. Hold the tender spots for 30 seconds to allow your muscle time to relax and release the knots that are causing tension in the muscle. After you have completed the foam rolling, statically stretch the chest and lats. Hold each stretch for 30 seconds to allow your muscles time to elongate. Next, perform strengthening exercises for the shoulder and core. This can be done by performing stability ball bridges (to help strengthen the muscles that stabilize the core and hips) and the ball combo I (to strengthen the muscles in your shoulder complex). Perform 1-3 sets of 10-15 repetitions of each of these exercises.

Dr. Ron Noy, MD
Sports Medicine Specialist
Most rotator cuff tears are partial or small, and usually do not require surgery. A proper strengthening program at the gym and/or with a physical therapist may be all that is needed to get rid of the pain in the shoulder and improve function. Occasionally, a cortisone injection may be necessary to keep inflammation down during the recovery process, but is an adjunct to the exercise program and not in lieu of it. I like to teach my patients what I call the “No Pain Principle Program” which is the opposite of the “No Pain, No Gain” mentality most of us were raised on as athletes. Essentially this had 3 components:
  1. Painless zone of motion strengthening in 3 planes of the rotator cuff (external rotation, internal rotation and abduction). If you are moving through a painful spot during the exercise, then you are potentially injuring the cuff further and causing more inflammation later, which weakens the cuff.
  2. Scapular (shoulder blade) stabilization exercises, but particularly anything that causes you to stick your chest out when doing them, such as rowing and reverse shoulder shrugs. This will move the acromion bone and/or subacromial bone spur (which are above the top of the rotator cuff and can dig into the cuff during reaching, sleeping and other activities) away from the cuff, thereby opening the space and potentially increasing the painless zone of motion exercises in step Ice the shoulder for 10 minutes afterwards. The reason an NFL quarterback ices his shoulder after a game is not for pain -- every bone in his body hurts after a game -- but rather to prevent the inflammation that will occur later from throwing a football for 3 hours. 
Follow these principles and surgery most oftentimes will be avoided. However, there is a simple test which I teach my students and patients that will predicts whether this will work. If the test is negative, arthroscopic surgery may be necessary. Likewise, if you have a large full thickness tear, surgery is often necessary to repair the tendon back to the bone. This will allow improved function, reduced pain, and promote proper mechanics to help avoid arthritis in the future.
Rotator cuff tears are treated according to the size, location and chronicity of the tear. A partial tear may not require a repair, but a simple debridement (trimming) of torn tissue. A complete tear requires reattaching the torn tendon back to the humerus (upper arm bone). This is typically done with suture anchors, where an anchor is placed in the bone and the suture attached to the anchor is then looped around the torn edge of the tendon. The tendon is then positioned back to the bone and tied in place.
Both debridements and repairs are typically done arthroscopically. However, for very large rotator cuff tears, an open incision may be required for optimal visualization.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.