Rotator Cuff Injuries: Treatment

There are several treatment options for rotator cuff injuries. Partial and degenerative rotator cuff injuries often respond to rest, non-surgical treatments, and in some cases, injections.

In rare cases, surgery is considered.

Non-surgical Treatments

Rotator cuff injury treatment typically begins with non-surgical methods. This approach has three phases:

1. Acute phase

The phase focuses on controlling pain and inflammation, protecting the muscles and tendons, and preventing further injury to the painful tissues.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and pain.
  • NSAIDs are available as oral tablets (eg, Advil) and topical ointments (eg, Voltaren), and can be purchased over the counter or with a prescription.
  • Oral NSAIDs are not suitable for all patients due to significant potential risks, such as gastric irritation and/or bleeding, and cardiac problems.
• Applying ice packs to the shoulder for 15-20 minutes 2-3 times per day reduces pain and swelling after physical activity and calms painful flare-ups. 
  A towel or other protective barrier must be used between the cold pack and the skin and application time should be limited to 20 minutes with a break of at least 2 hours before reapplying the ice pack. See 3 Useful Tips for Icing Your Injury
• A shoulder brace or sling may be used to limit shoulder movement. Immobilization of the shoulder should be as brief as possible, even with complete tears. Immobilization for long periods can lead to further complications, such as the loss of range of motion and a painful condition called shoulder adhesive capsulitis (frozen shoulder).  Even if a sling is used, range of motion exercises like pendulum circles should be done throughout the day to reduce stiffness and pain.

These treatments are typically advised for 1 to 2 weeks. Rotator cuff injection treatments may be recommended when medications fail to relieve pain.

2. Restorative phase

In this phase, healing is facilitated by allowing the muscle and tendon to repair and regenerate.

• Physical therapy for rotator cuff injuries focuses on:
  • Strengthening the rotator cuff muscles and tendons
  • Correcting strength and flexibility deficits or imbalances
  • Addressing stability and mobility issues surrounding the scapula, or shoulder blade, at the back of the shoulder
• Modifying daily activities reduces stress on the affected shoulder. Examples include avoiding lifting heavy objects and modifying the workstation to prevent strain on the shoulder muscles.
• Applying a dry or moist heat pack to the shoulder for 15-20 minutes 2-3 times per day reduces muscle tension and spasms. Heat therapy is useful before starting an exercise, sport, or physical activity.
  A towel or other protective barrier must be used between the heat pack and the skin and application time should be limited to 20 minutes with a break of at least 2 hours before reapplying the pack.
• Topical nitroglycerin is a medication available in the form of an adhesive topical patch and may help with both pain and healing by encouraging better blood flow. Nitroglycerin, often used as a heart medication, relaxes and widens blood vessels, bringing more blood flow and healing nutrients to the injured tissues.
• Ultrasound therapy uses high-frequency sound waves to stimulate tissue healing and reduce inflammation in deep musculoskeletal tissues. This therapy aims to increase blood flow and regenerate tissues – thereby promoting healing.
• Iontophoresis uses a mild electrical current to administer an anti-inflammatory medicine (such as dexamethasone) through healthy skin and into the sore area. Iontophoresis is an option for people who can't tolerate injections or want to avoid injections.
• Manual therapy is a hands-on technique performed by a trained healthcare professional, such as a chiropractor, physical therapist, or osteopath, and involves various procedures to:
  • Mobilize joints
  • Release muscle tension
  • Break down soft tissue restrictions, such as scar tissue

Manual therapy may be used along with physical therapy to accelerate muscle repair and improve outcomes in rotator cuff injuries. This combined treatment aims to reduce pain, improve function, speed up recovery, and prevent re-injury.¹Liu S, Chen L, Shi Q, et al. Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis. Biomed Rep. 2024;20(6):89. Published 2024 Apr 11. doi:10.3892/br.2024.1778

The restorative phase treatments continue for 6 to 12 weeks depending on the severity of the injury.

Surgery for Rotator Cuff Tears

Surgery is considered as an option for patients who:

• Are below 40 years of age
• Have full-thickness or high-grade tears from an acute injury
• Have progressive or unresolved symptoms from nonsurgical treatments and injections

Read more: Who Can Have Rotator Cuff Surgery?

Surgical repair of a rotator cuff is elective, meaning that it is the patient's decision whether or not to have surgery.

There are several types of rotator cuff surgery and the considerations vary for each.

See Rotator Cuff Surgery Risks and Complications