Saturday, December 28, 2013

What can be done for rotator cuff tears without surgery?

Individuals with rotator cuff tears can do well without surgery.

Readers will also be interested in this recent randomized study comparing non-operative management, acromioplasty and cuff repair in the treatment of non-traumatic cuff tears.
With the exception of an acute traumatic cuff tear that results in an abrupt loss of strength, there is usually an opportunity for non-operative management. This is particularly the case for partial thickness tears on one hand and larger atraumatic tears on the other.

Interestingly and importantly a high percentage of cuff tears are asymptomatic and need no treatment.

We recall that rotator cuff tears may be associated with symptoms of stiffness, weakness, crepitance and instability. We also know that rotator cuff repair requires prolonged protection of the repair so that the individual often cannot return to work or even activities of daily living for months after repair surgery. Therefore, we offer those individuals with non-acute cuff tears a trial of non-operative management emphasizing gentle stretching exercises - especially those directed at achieving a full range of passive motion (see here, especially exercises E,F, and G). It is always of interest to us that individuals with cuff pathology often lack internal rotation with the arm in abduction and that the 'sleeper stretch' (G) can go a long way to resolving this tightness and the associated shoulder pain. These exercises often help resolve the crepitance as well.

Again, shoulder stiffness is often overlooked. Shoulder stiffness can be diagnosed as shown here.

Some keys to successful stretching are shown here.

Once a full range of passive motion is achieved, gentle strengthening exercises can be initiated (H, I and J as shown here).

We avoid rubber tubing or other exercises that emphasize rotational strength in that these load the weakened cuff tendons.

We also avoid injections of steroids because of the weakening effect they have on the tendons.

Here is a post on the effectiveness of non-operative management of rotator cuff tears.
And here is another report on non-operative management of cuff tears.
And another article about improvement for cuff tears without surgery.
And yet another showing the effectiveness of non-operative management.
And here's a comparison of operative and non-operative treatment.

See more of the Rotator Cuff Book here.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link.

Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book

Click here to see the new Rotator Cuff Book

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