How are impingement and rotator cuff tears treated?
Impingement and rotator cuff tears can be treated non-operatively
or with surgery.
Treatment for both injuries usually begins with a non-operative treatment
plan. More than 2/3 of impingement patients can expect significant
improvement in their symptoms with a physical therapy program alone.
These results are lower in older patients and in those with large
When trauma causes a tear in younger patients, surgery is often the
first choice of treatment. Patients with this type of injury recover
best if surgery is done early. Generally, this pertains to those
patients under the age of fifty with tears less than four weeks old.
Non-operative treatment is similar for both impingement and rotator
cuff tears. A vast majority of patients improve with this primary
treatment alone. The goals of a physical therapy program include:
- strengthening the rotator cuff
- stretching and regaining lost motion
caused by pain and inflammation.
- allowing the humerus to be better
positioned under the acromion, thus reducing compression of the
Anti-inflammatory medication may be prescribed to help reduce
pain and inflammation. Many patients with rotator cuff tears can
function quite well if pain and inflammation are controlled with
medication and physical therapy. This is especially true for the
elderly and those with low demands on the shoulder.
Cross Arm Push
parallel to an elastic resistance cord, the elbow should
be bent 90 degrees at the side. The hand should slowly
rotate away from the body, using the elbow as a hinge.
Rotation should continue until the arm is in a neutral
is placed on the opposite shoulder. The other hand is
used to pull the elbow across the body until a good stretch
is felt on the back of the shoulder.
If symptoms have not improved with this program, the doctor may
recommend a steroid injection into the bursa. Cortisone,
or a similar steroid, is often combined with a local anesthetic
to help control the pain and inflammation of the bursa. Steroid
injections are used with caution. Damage to the rotator cuff tendons
may occur with more than two or three injections over several months.
Patients with diabetes are generally not good candidates for steroid
injections because of problems with glucose control.
A non-operative treatment plan is often all that is necessary for
most patients with impingement syndrome. However, the small percentage
of patients whose symptoms have not improved after 6 months of dedicated
physical therapy may be candidates for surgery. The shoulder should
be reevaluated to make sure no other problems exist.
decompression expands the space between the acromion
and rotator cuff tendons. This can be done either arthroscopically
or with open incisions, depending on the preference of the surgeon.
During an arthroscopy, a tiny fiberoptic instrument is inserted
into the joint. In many cases, the doctor can assess and repair
the damage through this scope without making large incisions. Scar
tissue or bone spurs can successfully be removed with either technique.
If a rotator cuff tear is found at the time of surgery, it can also
be repaired if necessary.
Rotator cuff tear
Not all rotator cuff tears require surgery. Many
patients are content with their progress following a non-operative
treatment plan. Patients who have been unable to regain lost motion
and strengthen the surrounding muscles sufficiently may need a rotator
cuff repair. This is often the case for the younger, more active
patients who want to address continued weakness following physical
Rotator cuff repairs can be performed either arthroscopically or with
open incisions. Arthroscopic techniques are new and limited to specific
types of tears. An open repair that secures the rotator cuff tendons
back to the humerus remains the surgical treatment of choice.
What types of complications may occur?
Complication rates after surgery are generally low. Pre-operative
antibiotics are given to reduce the slight risk of infection after
surgery. Infection tends to occur a little less often when arthroscopic
techniques are used. Risks of major bleeding or nerve damage are extremely
small. Postoperative stiffness is the major complication of both impingement
and rotator cuff tears.
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