Conservatively treat all patients with chronic injuries that have progressed to a rotator cuff tear. The goals are to reduce inflammation, relieve stress on the rotator cuff, and correct any biomechanical dysfunction. Steroid injections reduced pain, but showed no difference in improvement of function. Surgical therapy is indicated in patients younger than 60 years with a full-thickness tear demonstrated clinically or arthrographically, in patients who fail to improve after 6 weeks of rehabilitation, or in patients performing activity that requires shoulder use. Primarily, acute injuries or even severe extension of chronic rotator cuff injuries should warrant emergent orthopedic evaluation, for they have poor prognosis if conservative modalities are used.
Findings generally suggest that early treatment precipitates a better outcome.
Many studies have concluded that the need for surgery should consider not only age, but also type of tear, duration of symptoms, and ability of patient to comply with the rehabilitation regimen. Analgesics - Pain control is essential to quality patient care, ensuring patient comfort, promoting pulmonary toilet, and enabling physical therapy regimens. Most analgesics have sedating properties, which are beneficial for patients who have sustained painful skin lesions. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.