Rotator Cuff Tear Treatment Options

Not all rotator cuff tears require surgery. In fact, many partial tears and some small full-thickness tears can be effectively managed with nonsurgical treatments. Dr. Boden emphasizes a conservative approach when appropriate, tailoring treatment to the patient’s symptoms, activity level, goals, and overall health.

Physical Therapy

Physical therapy is a cornerstone of nonsurgical treatment for rotator cuff tears. A structured rehabilitation program focuses on strengthening the surrounding muscles to compensate for the torn tendon and improve shoulder stability. Stretching exercises are also incorporated to enhance flexibility and range of motion. Patients are guided through customized programs designed to reduce pain and restore function gradually.

Medications and Pain Management

Non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended to alleviate pain and reduce inflammation in the shoulder. Corticosteroid injections may be considered for patients with significant pain that interferes with daily activities. These injections provide temporary relief, allowing patients to engage in physical therapy more effectively.

Activity Modification

Dr. Boden advises patients to avoid activities that exacerbate their symptoms, such as overhead movements or lifting heavy objects. Modifying daily activities can help reduce strain on the rotator cuff and prevent further injury.

When conservative nonsurgical management fails to alleviate symptoms and/or when the tear is large and causing significant dysfunction, surgery may be necessary to restore shoulder function and relieve persistent pain.

Surgery is often recommended for tears caused by a sudden injury, such as a fall or lifting a heavy object. Acute tears, especially in younger or active individuals, have a better chance of successful repair and recovery when treated promptly with surgery.

What are the types of surgical procedures?

Dr. Boden specializes in both minimally invasive arthroscopic techniques and advanced open reconstruction procedures, offering patients the most effective and cutting-edge options. The surgical procedure is tailored specifically to the patient and their needs taking into account age, activity level, and tear severity. Some of the procedures she offers include arthroscopic rotator cuff repair, open rotator cuff repair, subacromial balloon spacer, superior capsule reconstruction, tendon transfer surgery, and reverse total shoulder replacement.

Arthroscopic Rotator Cuff Repair

Arthroscopic surgery is a minimally invasive procedure that uses small incisions and a camera (arthroscope) to visualize the shoulder joint. Specialized instruments are used to repair the torn tendon and reattach it to the bone. This technique is associated with less postoperative pain, a lower risk of complications, and faster recovery times compared to traditional open surgery. Dr. Boden’s expertise in arthroscopy ensures precise repair while minimizing tissue damage.

Open Rotator Cuff Repair

For complex or massive tears, open rotator cuff repair may be the most appropriate approach. In this procedure, a larger incision is made to provide direct access to the shoulder joint. Open surgery allows for better visualization of extensive damage and may be necessary for patients with large or chronic tears, significant tendon retraction, or poor-quality tissue. Dr. Boden utilizes advanced techniques to optimize outcomes, including specialized sutures and grafts to reinforce the repair.

Tendon Transfer Surgery

In cases where the rotator cuff tear is irreparable due to severe degeneration or retraction, Dr. Boden may perform tendon transfer surgery. This procedure involves using a nearby tendon to restore shoulder function. Tendon transfer surgery is particularly beneficial for younger, active patients who wish to regain strength and mobility.

Reverse Total Shoulder Replacement

For patients with rotator cuff tear arthropathy—a condition characterized by arthritis and a long-standing massive rotator cuff tear—reverse total shoulder replacement may be the best option. This procedure involves replacing the shoulder joint with a prosthetic device that relies on the deltoid muscle for movement, compensating for the deficient rotator cuff. Dr. Boden’s experience in complex shoulder reconstruction ensures optimal outcomes for patients with advanced joint damage.

Following surgery, a comprehensive rehabilitation program is essential to achieve a successful outcome. Dr. Boden works closely with physical therapists to design individualized recovery plans. The rehabilitation process typically progresses through several phases:

Protection Phase

After surgery, the shoulder is immobilized in a sling to allow the repaired tendon to heal. This phase usually lasts 4-6 weeks. During this phase, gentle passive range-of-motion exercises under the guidance of a physical therapist begins.

Active Range of Motion

Patients start active range-of-motion exercises under the guidance of a physical therapist usually between 4-6 weeks after surgery depending on the extent of the surgical repair.

Strengthening Exercises

Gradual strengthening exercises are introduced to rebuild muscle and improve joint stability. This phase focuses on restoring function and preventing future injuries.

Return to Activities

Most patients can return to light activities within 3 months and resume sports or heavy labor within 6-12 months, depending on the extent of the surgery and individual progress.