Skip to main content
Log in

Evidence-based Management of Rotator Cuff Tears (Acute and Chronic)

  • Sports Medicine Rehabilitation (J Soo Hoo and B Liem, Section Editors)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper should serve as a guide for nonoperative physicians in the management of rotator cuff tears and provide an algorithm of when to refer patients for potential operative repair.

Recent Findings

While physical therapy remains the mainstay of conservative treatment, recent studies have examined various injections to improve pain and function in partial- and/or full-thickness rotator cuff tears, such as suprascapular nerve blocks, subacromial hyaluronic acid, and intratendinous platelet-rich plasma.

Summary

Patients who experience an acute, full-thickness rotator cuff tear should be referred as soon as possible for potential surgical repair; however, clinicians should consider the patient’s age and activity level. The algorithms for both acute partial-thickness tears and chronic degenerative rotator cuff tears are similar and should initially include a conservative approach of pain control, physical therapy, and potentially various injections before possible referral for surgical evaluation. We anticipate future research examining the role for biologic agents in the conservative treatment of rotator cuff tears.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007;455:52–63. https://doi.org/10.1097/BLO.0b013e31802fc175.

    Article  PubMed  Google Scholar 

  2. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10–5. https://doi.org/10.2106/00004623-199501000-00002.

    Article  CAS  PubMed  Google Scholar 

  3. Löhr JF, Uhthoff HK. Epidemiology and pathophysiology of rotator cuff tears. Orthopade. 2007;36(9):788–95. https://doi.org/10.1007/s00132-007-1146-8.

    Article  PubMed  Google Scholar 

  4. Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors affecting cost, outcomes, and tendon healing after arthroscopic rotator cuff repair. Arthroscopy. 2018;34(5):1393–400. https://doi.org/10.1016/j.arthro.2017.11.015.

    Article  PubMed  Google Scholar 

  5. Ensor KL, Kwon YW, Dibeneditto MR, Zuckerman JD, Rokito AS. The rising incidence of rotator cuff repairs. J Shoulder Elbow Surg. 2013;22(12):1628–32. https://doi.org/10.1016/j.jse.2013.01.006.

    Article  PubMed  Google Scholar 

  6. Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord. 2014;15:4. https://doi.org/10.1186/1471-2474-15-4.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jacobson JA. Fundamentals of musculoskeletal ultrasound. 3rd ed. Philadelphia, PA: Elsevier; 2018.

    Google Scholar 

  8. Matava MJ, Purcell DB, Rudzki JR. Partial-thickness rotator cuff tears. Am J Sports Med. 2005;33(9):1405–17. https://doi.org/10.1177/0363546505280213.

    Article  PubMed  Google Scholar 

  9. Ellman H, Kay SP. Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results. J Bone Joint Surg Br. 1991;73(3):395–8. https://doi.org/10.1302/0301-620X.73B3.1670435

  10. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563–7.

    Article  CAS  Google Scholar 

  11. Loew M, Magosch P, Lichtenberg S, Habermeyer P, Porschke F. How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elbow Surg. 2015;24(11):1685–93. https://doi.org/10.1016/j.jse.2015.06.005.

    Article  PubMed  Google Scholar 

  12. Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP. Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am. 1991;73(1):17–29

  13. Wohlwend JR, van Holsbeeck M, Craig J, Shirazi K, Habra G, Jacobsen G, et al. The association between irregular greater tuberosities and rotator cuff tears: a sonographic study. AJR Am J Roentgenol. 1998;171(1):229–33. https://doi.org/10.2214/ajr.171.1.9648794.

    Article  CAS  PubMed  Google Scholar 

  14. Teefey SA, Middleton WD, Bauer GS, Hildebolt CF, Yamaguchi K. Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears. J Ultrasound Med. 2000;19(6):377–8; quiz 83. https://doi.org/10.7863/jum.2000.19.6.377

  15. Rodriguez-Santiago B, Castillo B, Baerga-Varela L, Micheo WF. Rehabilitation management of rotator cuff injuries in the master athlete. Curr Sports Med Rep. 2019;18(9):330–7. https://doi.org/10.1249/JSR.0000000000000628.

    Article  PubMed  Google Scholar 

  16. Moosmayer S, Gärtner AV, Tariq R. The natural course of nonoperatively treated rotator cuff tears: an 8.8-year follow-up of tear anatomy and clinical outcome in 49 patients. J Shoulder Elbow Surg. 2017;26(4):627–34. https://doi.org/10.1016/j.jse.2016.10.002

  17. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898–906. https://doi.org/10.2106/JBJS.G.01335.

    Article  PubMed  Google Scholar 

  18. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011;39(4):710–4. https://doi.org/10.1177/0363546510393944.

    Article  PubMed  Google Scholar 

  19. Lo IK, Denkers MR, More KD, Nelson AA, Thornton GM, Boorman RS. Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment. Open Access J Sports Med. 2018;9:191–7. https://doi.org/10.2147/OAJSM.S153236.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016(6):CD012224. https://doi.org/10.1002/14651858.CD012224

  21. Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med. 2007;41(4):200–10. https://doi.org/10.1136/bjsm.2006.032524.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jeanfavre M, Husted S, Leff G. Exercise therapy in the non-operative treatment of full-thickness rotator cuff tears: a systematic review. Int J Sports Phys Ther. 2018;13(3):335–78.

    Article  Google Scholar 

  23. Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. J Bone Joint Surg Am. 2014;96(18):1504–14. https://doi.org/10.2106/JBJS.M.01393.

    Article  PubMed  Google Scholar 

  24. Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow-up. J Bone Joint Surg Am. 2015;97(21):1729–37. https://doi.org/10.2106/JBJS.N.01051.

    Article  PubMed  Google Scholar 

  25. Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol. 1982;127(3):417–20. https://doi.org/10.1016/s0022-5347(17)53841-0.

    Article  CAS  PubMed  Google Scholar 

  26. Reilly JM, Bluman E, Tenforde AS. Effect of shockwave treatment for management of upper and lower extremity musculoskeletal conditions: a narrative review. PM R. 2018;10(12):1385–403. https://doi.org/10.1016/j.pmrj.2018.05.007.

    Article  PubMed  Google Scholar 

  27. Galasso O, Amelio E, Riccelli DA, Gasparini G. Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial. BMC Musculoskelet Disord. 2012;13:86. https://doi.org/10.1186/1471-2474-13-86.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ioppolo F, Tattoli M, Di Sante L, Attanasi C, Venditto T, Servidio M, et al. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys Ther. 2012;92(11):1376–85. https://doi.org/10.2522/ptj.20110252.

    Article  PubMed  Google Scholar 

  29. Chou WY, Wang CJ, Wu KT, Yang YJ, Cheng JH, Wang SW. Comparative outcomes of extracorporeal shockwave therapy for shoulder tendinitis or partial tears of the rotator cuff in athletes and non-athletes: Retrospective study. Int J Surg. 2018;51:184–90. https://doi.org/10.1016/j.ijsu.2018.01.036.

    Article  PubMed  Google Scholar 

  30. Oliveira VOM, Vergara JM, Oliveira VF, Lara PHS, Nogueira LC, Arliani GG. Extracorporeal shockwave therapy in shoulder injuries: prospective study. Acta Ortop Bras. 2021;29(5):268–73. https://doi.org/10.1590/1413-785220212905237628.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003;21(6):984–9. https://doi.org/10.1016/S0736-0266(03)00104-9

  32. Chen YJ, Wang CJ, Yang KD, Kuo YR, Huang HC, Huang YT, et al. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. J Orthop Res. 2004;22(4):854–61. https://doi.org/10.1016/j.orthres.2003.10.013.

    Article  CAS  PubMed  Google Scholar 

  33. Haraldsson BT, Langberg H, Aagaard P, Zuurmond AM, van El B, Degroot J, et al. Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med. 2006;34(12):1992–7. https://doi.org/10.1177/0363546506290402.

    Article  PubMed  Google Scholar 

  34. Mikolyzk DK, Wei AS, Tonino P, Marra G, Williams DA, Himes RD, et al. Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon. J Bone Joint Surg Am. 2009;91(5):1172–80. https://doi.org/10.2106/JBJS.H.00191.

    Article  PubMed  Google Scholar 

  35. Weber AE, Trasolini NA, Mayer EN, Essilfie A, Vangsness CT, Gamradt SC, et al. Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates. Arthroscopy. 2019;35(3):717–24. https://doi.org/10.1016/j.arthro.2018.10.116.

    Article  PubMed  Google Scholar 

  36. Traven SA, Brinton D, Simpson KN, Adkins Z, Althoff A, Palsis J, et al. Preoperative shoulder injections are associated with increased risk of revision rotator cuff repair. Arthroscopy. 2019;35(3):706–13. https://doi.org/10.1016/j.arthro.2018.10.107.

    Article  PubMed  Google Scholar 

  37. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003(1):CD004016. https://doi.org/10.1002/14651858.CD004016

  38. Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg. 2013;22(5):595–601. https://doi.org/10.1016/j.jse.2012.08.026.

    Article  PubMed  Google Scholar 

  39. Almekinders LC, Banes AJ, Ballenger CA. Effects of repetitive motion on human fibroblasts. Med Sci Sports Exerc. 1993;25(5):603–7.

    Article  CAS  Google Scholar 

  40. Radi ZA, Khan NK. Effects of cyclooxygenase inhibition on bone, tendon, and ligament healing. Inflamm Res. 2005;54(9):358–66. https://doi.org/10.1007/s00011-005-1367-4.

    Article  CAS  PubMed  Google Scholar 

  41. Ajmani ML. The cutaneous branch of the human suprascapular nerve. J Anat. 1994;185(Pt 2):439–42.

    PubMed  PubMed Central  Google Scholar 

  42. Price DJ. What local anesthetic volume should be used for suprascapular nerve block? Reg Anesth Pain Med. 2008;33(6):571; author reply -3. https://doi.org/10.1097/00115550-200811000-00010

  43. Chan CW, Peng PW. Suprascapular nerve block: a narrative review. Reg Anesth Pain Med. 2011;36(4):358–73. https://doi.org/10.1097/AAP.0b013e3182204ec0.

    Article  PubMed  Google Scholar 

  44. Harmon D, Hearty C. Ultrasound-guided suprascapular nerve block technique. Pain Physician. 2007;10(6):743–6.

    PubMed  Google Scholar 

  45. Vecchio PC, Adebajo AO, Hazleman BL. Suprascapular nerve block for persistent rotator cuff lesions. J Rheumatol. 1993;20(3):453–5.

    CAS  PubMed  Google Scholar 

  46. Di Lorenzo L, Pappagallo M, Gimigliano R, Palmieri E, Saviano E, Bello A, et al. Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block? Eura Medicophys. 2006;42(3):195–204.

    PubMed  Google Scholar 

  47. • Coory JA, Parr AF, Wilkinson MP, Gupta A. Efficacy of suprascapular nerve block compared with subacromial injection: a randomized controlled trial in patients with rotator cuff tears. J Shoulder Elbow Surg. 2019;28(3):430–6. https://doi.org/10.1016/j.jse.2018.11.051. (This study suggests that suprascapular nerve block can lead to significantly improved short-term pain and function for both partial- and full-thickness symptomatic rotator cuff tears.)

    Article  PubMed  Google Scholar 

  48. Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;5(2):54–67. https://doi.org/10.1186/ar623.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Moghtaderi A, Sajadiyeh S, Khosrawi S, Dehghan F, Bateni V. Effect of subacromial sodium hyaluronate injection on rotator cuff disease: a double-blind placebo-controlled clinical trial. Adv Biomed Res. 2013;2:89. https://doi.org/10.4103/2277-9175.122517.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Chou WY, Ko JY, Wang FS, Huang CC, Wong T, Wang CJ, et al. Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J Shoulder Elbow Surg. 2010;19(4):557–63. https://doi.org/10.1016/j.jse.2009.08.006.

    Article  PubMed  Google Scholar 

  51. Gigante A, Cecconi S, Enea D, Cesari E, Valeri G, Busilacchi A. Effect of subacromial injections of hyaluron on different grades of rotator cuff lesion: a prospective study. Eur J Inflamm. 2013;11(3):777–87. https://doi.org/10.1177/1721727X1301100320.

    Article  CAS  Google Scholar 

  52. Khan M, Shanmugaraj A, Prada C, Patel A, Babins E, Bhandari M. The role of hyaluronic acid for soft tissue indications: a systematic review and meta-analysis. Sports Health. 2022:19417381211073316. https://doi.org/10.1177/19417381211073316

  53. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259–72. https://doi.org/10.1177/0363546509349921.

    Article  PubMed  Google Scholar 

  54. Andia I, Rubio-Azpeitia E, Maffulli N. Platelet-rich plasma modulates the secretion of inflammatory/angiogenic proteins by inflamed tenocytes. Clin Orthop Relat Res. 2015;473(5):1624–34. https://doi.org/10.1007/s11999-015-4179-z.

    Article  PubMed  PubMed Central  Google Scholar 

  55. • Prodromos CC, Finkle S, Prodromos A, Chen JL, Schwartz A, Wathen L. Treatment of rotator cuff tears with platelet rich plasma: a prospective study with 2 year follow-up. BMC Musculoskelet Disord. 2021;22(1):499. https://doi.org/10.1186/s12891-021-04288-4. (Findings from this study suggest that PRP can provide long-term improvements in pain and function in patients with partial rotator cuff tears.)

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kwong CA, Woodmass JM, Gusnowski EM, Bois AJ, Leblanc J, More KD, et al. Platelet-rich plasma in patients with partial-thickness rotator cuff tears or tendinopathy leads to significantly improved short-term pain relief and function compared with corticosteroid injection: a double-blind randomized controlled trial. Arthroscopy. 2021;37(2):510–7. https://doi.org/10.1016/j.arthro.2020.10.037.

    Article  PubMed  Google Scholar 

  57. Chen X, Jones IA, Togashi R, Park C, Vangsness CT. Use of platelet-rich plasma for the improvement of pain and function in rotator cuff tears: a systematic review and meta-analysis with bias assessment. Am J Sports Med. 2020;48(8):2028–41. https://doi.org/10.1177/0363546519881423.

    Article  PubMed  Google Scholar 

  58. Xiang XN, Deng J, Liu Y, Yu X, Cheng B, He HC. Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis. Clin Rehabil. 2021;35(12):1661–73. https://doi.org/10.1177/02692155211011944.

    Article  PubMed  Google Scholar 

  59. Wang C, Zhang Z, Ma Y, Liu X, Zhu Q. Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: a protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(7):e24680. https://doi.org/10.1097/MD.0000000000024680.

    Article  Google Scholar 

  60. Lui M, Shih W, Yim N, Brandstater M, Ashfaq M, Tran D. Systematic review and meta-analysis of nonoperative platelet-rich plasma shoulder injections for rotator cuff pathology. PM R. 2021;13(10):1157–68. https://doi.org/10.1002/pmrj.12516.

    Article  PubMed  Google Scholar 

  61. Robinson DM, Eng C, Makovitch S, Rothenberg JB, DeLuca S, Douglas S, et al. Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: a systematic review. J Back Musculoskelet Rehabil. 2021;34(1):17–32. https://doi.org/10.3233/BMR-201844.

    Article  PubMed  Google Scholar 

  62. Mautner K, Malanga GA, Smith J, Shiple B, Ibrahim V, Sampson S, et al. A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM R. 2015;7(4 Suppl):S53–9. https://doi.org/10.1016/j.pmrj.2015.02.005.

    Article  PubMed  Google Scholar 

  63. Giovannetti De Sanctis E, Franceschetti E, De Dona F, Palumbo A, Paciotti M, Franceschi F. The efficacy of injections for partial rotator cuff tears: a systematic review. J Clin Med. 2020;10(1):51. https://doi.org/10.3390/jcm10010051

  64. Cai YU, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Med Sci Sports Exerc. 2019;51(2):227–33. https://doi.org/10.1249/MSS.0000000000001781.

    Article  CAS  PubMed  Google Scholar 

  65. Caplan AI. Adult Mesenchymal stem cells: when, where, and how. Stem Cells Int. 2015;2015:1–6. https://doi.org/10.1155/2015/628767.

    Article  CAS  Google Scholar 

  66. Caplan AI, Dennis JE. Mesenchymal stem cells as trophic mediators. J Cell Biochem. 2006;98(5):1076–84. https://doi.org/10.1002/jcb.20886.

    Article  CAS  PubMed  Google Scholar 

  67. Marathe A, Song B, Jayaram P. Microfragmented adipose tissue with adjuvant platelet-rich plasma combination therapy for partial-thickness supraspinatus tear. Cureus. 2021;13(6):e15583. https://doi.org/10.7759/cureus.15583.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Cherian C, Malanga GA, Hogaboom N, Pollack MA, Dyson-Hudson TA. Autologous, micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report. Spinal Cord Ser Cases. 2019;5:46. https://doi.org/10.1038/s41394-019-0186-8.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Hogaboom N, Malanga G, Cherian C, Dyson-Hudson T. A pilot study to evaluate micro-fragmented adipose tissue injection under ultrasound guidance for the treatment of refractory rotator cuff disease in wheelchair users with spinal cord injury. J Spinal Cord Med. 2021;44(6):886–95. https://doi.org/10.1080/10790268.2021.1903140.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Jo CH, Chai JW, Jeong EC, Oh S, Yoon KS. Intratendinous injection of mesenchymal stem cells for the treatment of rotator cuff disease: a 2-year follow-up study. Arthroscopy. 2020;36(4):971–80. https://doi.org/10.1016/j.arthro.2019.11.120.

    Article  PubMed  Google Scholar 

  71. Kim SJ, Kim EK, Song DH. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res. 2018;13(1):1. https://doi.org/10.1186/s13018-017-0693-x.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Centeno C, Fausel Z, Stemper I, Azuike U, Dodson E. A Randomized controlled trial of the treatment of rotator cuff tears with bone marrow concentrate and platelet products compared to exercise therapy: a midterm analysis. Stem Cells Int. 2020;2020:5962354. https://doi.org/10.1155/2020/5962354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Brindisino F, Salomon M, Giagio S, Pastore C, Innocenti T. Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2021;30(11):2648–59. https://doi.org/10.1016/j.jse.2021.04.040

  74. Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. Int Orthop. 2015;39(12):2403–14. https://doi.org/10.1007/s00264-015-2796-5.

    Article  PubMed  Google Scholar 

  75. Weber S, Chadal J. Management of rotator cuff injuries. J Am Acad Orthop Surg. 2020;28(5):e193–e201. https://doi.org/10.5435/JAAOS-D-19-00463.

  76. Rashid MS, Cooper C, Cook J, Cooper D, Dakin SG, Snelling S, et al. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year. Acta Orthop. 2017;88(6):606–11. https://doi.org/10.1080/17453674.2017.1370844.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Kim IB, Kim MW. Risk Factors for retear after arthroscopic repair of full-thickness rotator cuff tears using the suture bridge technique: classification system. Arthroscopy. 2016;32(11):2191–200. https://doi.org/10.1016/j.arthro.2016.03.012.

    Article  PubMed  Google Scholar 

  78. Deniz G, Kose O, Tugay A, Guler F, Turan A. Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg. 2014;134(7):985–90. https://doi.org/10.1007/s00402-014-2009-5.

    Article  PubMed  Google Scholar 

  79. Kim YK, Jung KH, Kim JW, Kim US, Hwang DH. Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg. 2018;27(6):1012–20. https://doi.org/10.1016/j.jse.2017.11.016.

    Article  PubMed  Google Scholar 

  80. Tashjian RZ, Henn RF, Kang L, Green A. Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am. 2006;88(3):536–40. https://doi.org/10.2106/JBJS.E.00418.

    Article  PubMed  Google Scholar 

  81. Naimark M, Robbins CB, Gagnier JJ, Landfair G, Carpenter J, Bedi A, et al. Impact of smoking on patient outcomes after arthroscopic rotator cuff repair. BMJ Open Sport Exerc Med. 2018;4(1):e000416. https://doi.org/10.1136/bmjsem-2018-000416.

    Article  PubMed  PubMed Central  Google Scholar 

  82. • Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg Am. 2019;101(12):1050–60. https://doi.org/10.2106/JBJS.18.01373. (Findings from this study suggest that patients with small- or medium-sized full thickness rotator cuff tears (<3cm) may have significantly improved pain and function long term after operative repair compared to physical therapy alone.)

    Article  PubMed  Google Scholar 

  83. Pandey V, Bandi A, Madi S, Agarwal L, Acharya KK, Maddukuri S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg. 2016;25(8):1312–22. https://doi.org/10.1016/j.jse.2016.01.036.

    Article  PubMed  Google Scholar 

  84. Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2015;43(9):2102–10. https://doi.org/10.1177/0363546515587081.

    Article  PubMed  Google Scholar 

  85. Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N, et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014;38(9):1811–8. https://doi.org/10.1007/s00264-014-2391-1.

    Article  PubMed  Google Scholar 

  86. Mall NA, Lee AS, Chahal J, Sherman SL, Romeo AA, Verma NN, et al. An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy. 2013;29(2):366–76. https://doi.org/10.1016/j.arthro.2012.06.024.

    Article  PubMed  Google Scholar 

  87. Matthewson G, Beach CJ, Nelson AA, Woodmass JM, Ono Y, Boorman RS, et al. Partial thickness rotator cuff tears: current concepts. Adv Orthop. 2015;2015:458786. https://doi.org/10.1155/2015/458786.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Kim YS, Lee HJ, Kim JH, Noh DY. When should we repair partial-thickness rotator cuff tears? Outcome comparison between immediate surgical repair versus delayed repair after 6-month period of nonsurgical treatment. Am J Sports Med. 2018;46(5):1091–6. https://doi.org/10.1177/0363546518757425.

    Article  PubMed  Google Scholar 

  89. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604. https://doi.org/10.1016/j.csm.2012.07.001.

    Article  PubMed  Google Scholar 

  90. Liu JN, Garcia GH, Gowd AK, Cabarcas BC, Charles MD, Romeo AA, et al. Treatment of partial thickness rotator cuff tears in overhead athletes. Curr Rev Musculoskelet Med. 2018;11(1):55–62. https://doi.org/10.1007/s12178-018-9459-2.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Lähteenmäki HE, Virolainen P, Hiltunen A, Heikkilä J, Nelimarkka OI. Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elbow Surg. 2006;15(2):148–53. https://doi.org/10.1016/j.jse.2005.07.006.

    Article  PubMed  Google Scholar 

  92. Ranebo MC, Björnsson Hallgren HC, Holmgren T, Adolfsson LE. Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. J Shoulder Elbow Surg. 2020;29(3):459–70. https://doi.org/10.1016/j.jse.2019.10.013.

    Article  PubMed  Google Scholar 

  93. Patel M, Amini MH. Management of acute rotator cuff tears. Orthop Clin North Am. 2022;53(1):69–76. https://doi.org/10.1016/j.ocl.2021.08.003.

    Article  PubMed  Google Scholar 

  94. Hantes ME, Karidakis GK, Vlychou M, Varitimidis S, Dailiana Z, Malizos KN. A comparison of early versus delayed repair of traumatic rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2011;19(10):1766–70. https://doi.org/10.1007/s00167-011-1396-1.

    Article  PubMed  Google Scholar 

  95. Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg. 2011;20(1):62–8. https://doi.org/10.1016/j.jse.2010.04.045.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert L. Bowers.

Ethics declarations

Conflicts of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sports Medicine Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pasculli, R.M., Bowers, R.L. Evidence-based Management of Rotator Cuff Tears (Acute and Chronic). Curr Phys Med Rehabil Rep 10, 239–247 (2022). https://doi.org/10.1007/s40141-022-00363-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-022-00363-6

Keywords

Navigation