Skip to main content
SpringerLink
Log in

Nonoperative Management: Natural History, Medications, and Injections

  • Chapter
  • First Online:
Massive Rotator Cuff Tears

  • 1719 Accesses

Abstract

The natural history of massive rotator cuff tears is not well known. Nonoperative treatment for patients with massive rotator cuff tears involves a combination of rest, activity modification, medications, physical therapy, and steroid injections. Nonoperative treatment is successful in decreasing pain in a large number of patients in short to midterm follow-up, especially lower-demand patients, but less satisfactory results may be seen in the long term. Patient function with nonoperative treatment is highly dependent on their pretreatment range of motion and function. The addition of steroid injections to the nonoperative treatment approach does seem to offer additional benefit in regard to pain reduction. Nonoperative treatment, however, does not prevent the development of degenerative changes in the glenohumeral joint and tear progression, including an increase in fatty infiltration and muscle atrophy. Therefore, outcomes may deteriorate over time.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007;89(9):1928–34.

    Article  PubMed  CAS  Google Scholar 

  2. Uhthoff HK, Sarkar K. An algorithm for shoulder pain caused by soft-tissue disorders. Clin Orthop Relat Res. 1990;254:121–7.

    PubMed  Google Scholar 

  3. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116–20.

    Article  PubMed  Google Scholar 

  4. Codman EA. Rupture of the supraspinatus tendon. 1911. Clin Orthop Relat Res. 1990;254:3–26.

    Google Scholar 

  5. Wening JD, Hollis RF, Hughes RE, Kuhn JE. Quantitative morphology of full thickness rotator cuff tears. Clin Anat. 2002;15(1):18–22.

    Article  PubMed  Google Scholar 

  6. Steinbacher P, Tauber M, Kogler S, Stoiber W, Resch H, Sanger AM. Effects of rotator cuff ruptures on the cellular and intracellular composition of the human supraspinatus muscle. Tissue Cell. 2010;42(1):37–41.

    Article  PubMed  CAS  Google Scholar 

  7. Bigliani LU, Cordasco FA, McLlveen SJ, Musso ES. Operative repair of massive rotator cuff tears: Long-term results. J Shoulder Elbow Surg. 1992;1(3):120–30.

    Article  PubMed  CAS  Google Scholar 

  8. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82(4):505–15.

    PubMed  CAS  Google Scholar 

  9. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90(11):2423–31.

    Article  PubMed  Google Scholar 

  10. Meyer DC, Lajtai G, von Rechenberg B, Pfirrmann CW, Gerber C. Tendon retracts more than muscle in experimental chronic tears of the rotator cuff. J Bone Joint Surg Br. 2006;88(11):1533–8.

    Article  PubMed  CAS  Google Scholar 

  11. Hersche O, Gerber C. Passive tension in the supraspinatus musculotendinous unit after long-standing rupture of its tendon: a preliminary report. J Shoulder Elbow Surg. 1998;7(4):393–6.

    Article  PubMed  CAS  Google Scholar 

  12. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    PubMed  Google Scholar 

  13. Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg. 2010;19(1):10–3.

    Article  PubMed  Google Scholar 

  14. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–6.

    PubMed  Google Scholar 

  15. Walch G, Marechal E, Maupas J, Liotard JP. Surgical treatment of rotator cuff rupture. Prognostic factors. Rev Chir Orthop Reparatrice Appar Mot. 1992;78(6):379–88.

    PubMed  CAS  Google Scholar 

  16. Weiner DS, Macnab I. Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br. 1970;52(3):524–7.

    PubMed  CAS  Google Scholar 

  17. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995;77(2):296–8.

    PubMed  CAS  Google Scholar 

  18. 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.

    PubMed  CAS  Google Scholar 

  19. Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg. 2011;20(2 Suppl):S20–9.

    Article  PubMed  Google Scholar 

  20. Itoi E, Minagawa H, Sato T, Sato K, Tabata S. Isokinetic strength after tears of the supraspinatus tendon. J Bone Joint Surg Br. 1997;79(1):77–82.

    Article  PubMed  CAS  Google Scholar 

  21. Neri BR, Chan KW, Kwon YW. Management of massive and irreparable rotator cuff tears. J Shoulder Elbow Surg. 2009;18(5):808–18.

    Article  PubMed  Google Scholar 

  22. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res. 2001;390:107–18.

    Article  PubMed  Google Scholar 

  23. Reuther KE, Sarver JJ, Schultz SM, Lee CS, Sehgal CM, Glaser DL, et al. Glenoid cartilage mechanical properties decrease after rotator cuff tears in a rat model. J Orthop Res. 2012;30(9):1435–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hsu HC, Luo ZP, Stone JJ, Huang TH, An KN. Correlation between rotator cuff tear and glenohumeral degeneration. Acta Orthop Scand. 2003;74(1):89–94.

    Article  PubMed  Google Scholar 

  25. Neer 2nd CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983;65(9):1232–44.

    PubMed  Google Scholar 

  26. Petersson CJ. Degeneration of the gleno-humeral joint. An anatomical study. Acta orthopaedica Scandinavica. 1983;54(2):277–83.

    Article  PubMed  CAS  Google Scholar 

  27. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;308:90–7.

    PubMed  Google Scholar 

  28. Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS. Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993;294:103–10.

    PubMed  Google Scholar 

  29. Brown JT. Early assessment of supraspinatus tears; procaine infiltration as a guide to treatment. J Bone Joint Surg. 1949;31B(3):423–5.

    CAS  Google Scholar 

  30. Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg Am. 1985;67(6):974–9.

    PubMed  CAS  Google Scholar 

  31. Hawkins RH, Dunlop R. Nonoperative treatment of rotator cuff tears. Clin Orthop Relat Res. 1995;321:178–88.

    PubMed  Google Scholar 

  32. Itoi E, Tabata S. Conservative treatment of rotator cuff tears. Clin Orthop Relat Res. 1992;275:165–73.

    PubMed  Google Scholar 

  33. Samilson RL, Binder WF. Symptomatic full thickness tears of rotator cuff. An analysis of 292 shoulders in 276 patients. Orthop Clin North Am. 1975;6(2):449–66.

    PubMed  CAS  Google Scholar 

  34. Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10(3):199–203.

    Article  PubMed  CAS  Google Scholar 

  35. Zvijac JE, Levy HJ, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy. 1994;10(5):518–23.

    Article  PubMed  CAS  Google Scholar 

  36. Steenbrink F, de Groot JH, Veeger HE, Meskers CG, van de Sande MA, Rozing PM. Pathological muscle activation patterns in patients with massive rotator cuff tears, with and without subacromial anaesthetics. Man Ther. 2006;11(3):231–7.

    Article  PubMed  CAS  Google Scholar 

  37. Kelly BT, Williams RJ, Cordasco FA, Backus SI, Otis JC, Weiland DE, et al. Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears. J Shoulder Elbow Surg. 2005;14(2):165–71.

    Article  PubMed  Google Scholar 

  38. Steenbrink F, de Groot JH, Veeger HE, van der Helm FC, Rozing PM. Glenohumeral stability in simulated rotator cuff tears. J Biomech. 2009;42(11):1740–5.

    Article  PubMed  CAS  Google Scholar 

  39. Iannotti JP, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, et al. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Joint Surg Am. 2006;88(2):342–8.

    Article  PubMed  Google Scholar 

  40. Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82(3):304–14.

    PubMed  CAS  Google Scholar 

  41. de Groot JH, van de Sande MA, Meskers CG, Rozing PM. Pathological Teres Major activation in patients with massive rotator cuff tears alters with pain relief and/or salvage surgery transfer. Clinical Biomech. 2006;21 Suppl 1:S27–32.

    Article  Google Scholar 

  42. Hawkes DH, Alizadehkhaiyat O, Kemp GJ, Fisher AC, Roebuck MM, Frostick SP. Shoulder muscle activation and coordination in patients with a massive rotator cuff tear: an electromyographic study. J Orthop Res. 2012;30(7):1140–6.

    Article  PubMed  Google Scholar 

  43. Feeney MS, O’Dowd J, Kay EW, Colville J. Glenohumeral articular cartilage changes in rotator cuff disease. J Shoulder Elbow Surg. 2003;12(1):20–3.

    Article  PubMed  Google Scholar 

  44. Itoi E, Motzkin NE, Morrey BF, An KN. Stabilizing function of the long head of the biceps in the hanging arm position. J Shoulder Elbow Surg. 1994;3(3):135–42.

    Article  PubMed  CAS  Google Scholar 

  45. Kumar VP, Satku K, Balasubramaniam P. The role of the long head of biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res. 1989;244:172–5.

    PubMed  Google Scholar 

  46. Perry J, Bekey GA. EMG-force relationships in skeletal muscle. Crit Rev Biomed Eng. 1981;7(1):1–22.

    PubMed  CAS  Google Scholar 

  47. Sakurai G, Ozaki J, Tomita Y, Nakagawa Y, Kondo T, Tamai S. Morphologic changes in long head of biceps brachii in rotator cuff dysfunction. J Orthop Sci. 1998;3(3):137–42.

    Article  PubMed  CAS  Google Scholar 

  48. Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89(4):747–57.

    Article  PubMed  Google Scholar 

  49. Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238–46.

    Article  PubMed  Google Scholar 

  50. Blazar PE, Williams GR, Iannotti JP. Spontaneous detachment of the deltoid muscle origin. J Shoulder Elbow Surg. 1998;7(4):389–92.

    Article  PubMed  CAS  Google Scholar 

  51. Ilaslan H, Iannotti JP, Recht MP. Deltoid muscle and tendon tears in patients with chronic rotator cuff tears. Skeletal Radiol. 2007;36(6):503–7.

    Article  PubMed  Google Scholar 

  52. Morisawa K, Yamashita K, Asami A, Nishikawa H, Watanabe H. Spontaneous rupture of the deltoid muscle associated with massive tearing of the rotator cuff. J Shoulder Elbow Surg. 1997;6(6):556–8.

    Article  PubMed  CAS  Google Scholar 

  53. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Goldberg BA, Nowinski RJ, Matsen 3rd FA. Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res. 2001;382:99–107.

    Article  PubMed  Google Scholar 

  55. Wirth MA, Basamania C, Rockwood Jr CA. Nonoperative management of full-thickness tears of the rotator cuff. Orthop Clin North Am. 1997;28(1):59–67.

    Article  PubMed  CAS  Google Scholar 

  56. Meyer DC, Hoppeler H, von Rechenberg B, Gerber C. A pathomechanical concept explains muscle loss and fatty muscular changes following surgical tendon release. J Orthop Sci. 2004;22(5):1004–7.

    Google Scholar 

  57. Ainsworth R. Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care. 2006;4(3):140–51.

    Article  PubMed  Google Scholar 

  58. Darlington LG, Coomes EN. The effects of local steroid injection for supraspinatus tears. Rheumatol Rehabil. 1977;16(3):172–9.

    Article  PubMed  CAS  Google Scholar 

  59. Vad VB, Warren RF, Altchek DW, O’Brien SJ, Rose HA, Wickiewicz TL. Negative prognostic factors in managing massive rotator cuff tears. Clin J Sport Med. 2002;12(3):151–7.

    Article  PubMed  Google Scholar 

  60. Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg. 2001;10(3):209–16.

    Article  PubMed  CAS  Google Scholar 

  61. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-Year follow-up. Am J Sports Med. 2013;41:2609–16.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2501-3303 Don Mills Rd, Toronto, ON, M2J 4T6, USA

    Bashar Alolabi MD, FRCSC

  2. Department of Orthopaedic Surgery, The Cleveland Clinic, Mail Code A40, 9500 Euclid Ave, Cleveland, OH, USA

    Eric T. Ricchetti MD

Authors
  1. Bashar Alolabi MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric T. Ricchetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric T. Ricchetti MD .

Editor information

Editors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    Lawrence V. Gulotta

  2. Professor of clinical surgery, Attending Surgeon, Medical School, Hospital for Special Surgery, New York, New York, USA

    Edward V. Craig

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Alolabi, B., Ricchetti, E.T. (2015). Nonoperative Management: Natural History, Medications, and Injections. In: Gulotta, L., Craig, E. (eds) Massive Rotator Cuff Tears. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7494-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-7494-5_4

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7493-8

  • Online ISBN: 978-1-4899-7494-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation