Medical Treatment

Chronic tear

• Pain control usually is the goal of treatment. This can be accomplished with rest and acetaminophen (Tylenol), aspirin, or ibuprofen.



• Occasionally, injections of steroids into the shoulder joint are helpful.



• Perform passive range-of-motion exercises (often best initially done with a physical therapist).



• People with continued pain may require surgery and follow-up with an orthopedic surgeon.

Acute tear

• Apply ice to decrease swelling. Wrap the ice in a cloth to avoid freezing the skin. Apply the wrapped ice 15-20 minutes at a time. This is most helpful in the first one to two days.



• Antiinflammatory medications may help reduce pain and swelling. Medicines such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) are examples available over the counter.



• Support the arm in a sling to rest the rotator cuff muscles. The sling may be taken off at night.



• The emergency physician may ask you to be seen for follow-up, either by a primary-care doctor or an orthopedic surgeon (specialist).



• Further imaging may be required to determine the degree and involvement of muscle tear. This is often done via magnetic resonance imaging.



• Early surgery (within three weeks) to repair the tendon is often needed, especially for younger, more active people.



• Indications for surgical treatment



• Usually for people younger than 60 years of age



• For complete tears



• An option after failure to improve after six weeks of proper treatment



• If the person has a job that requires constant shoulder use

Tendinitis

• Beginning care



• Apply ice packs for 20-minute periods several times a day.



• Rest the shoulder in a sling for a short period of time. Prolonged use of the sling can cause stiffness, weakness, and loss of motion of the shoulder joint.



• Take antiinflammatory medicines, such as ibuprofen or naproxen sodium.



• More severe cases



• Use the techniques described for beginning care.



• Injections of steroids may be given into the shoulder joint.



• As things improve (two to three days), discontinue the use of ice. Apply heat packs with massage.



• Perform Codman exercises. These are passive range-of-motion exercises (often initially done with a physical therapist). These exercises are done to increase slowly the amount of motion of the shoulder while putting a low amount of stress on the rotator cuff itself. The exercises are performed as the person leans toward the injured side with the arm hanging freely and slowly moving the arm in a circle. Initially, the circles are small. With improvement and decrease in pain, the circles enlarge.
  
  
• Also, holding a broomstick with both hands and moving them in a large arc while relaxing the affected shoulder can passively stretch the soft tissues. Later, active motion may be achieved by walking your fingers up a wall with the affected arm.

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