Rotator Cuff Injury (cont.)
What Are Home Remedies for Rotator Cuff Injuries?
- Rest and ice are the first-line home treatment of any sprain or strain.
- Apply ice for 15-20-minute periods at least three times a day.
- A sling may be helpful to rest the shoulder in an acute injury, but care must be taken not to wear the sling for too long, otherwise the shoulder joint will become stiff and may require significant time and effort in regaining any lost range of motion.
- Anti-inflammatory medications such as ibuprofen or naproxen may help decrease the pain and swelling of the injury. These over-the-counter medications should be taken with care if there are underlying stomach or kidney problems or if the patient is taking a blood thinner like warfarin (Coumadin), heparin (Lovenox), dabigatran (Pradaxa), apixaban (Eliquis), or rivaroxaban (Xarelto). It is always appropriate to check with a health care provider or pharmacist to determine the safety of over-the-counter medications.
What Is the Treatment for a Rotator Cuff Injury?
Initial treatment of a rotator cuff injury begins with rest, ice, and physical therapy to strengthen the muscles of the rotator cuff and to reestablish full range of motion of the shoulder. It may take weeks or longer to reach satisfactory healing.
There are other nonsurgical options available for treatment of rotator cuff injuries, including steroid injections to decrease inflammation in the tight spaces where the muscle tendons run across the shoulder joint, therapeutic ultrasound, shockwave therapy, and dry needling.
If early conservative treatments don't work or if there is a complete tear of the rotator cuff, surgery may be the next alternative to repair those tears that have been identified. As well, other problems may be addressed at time of surgery including debridement (cleaning up) of bone spurs, relieving any areas of muscle or tendon impingement, tightening the joint capsule, or repairing a labrum tear.
An orthopedic surgeon may use an arthroscope (an instrument that is inserted through a small incision) to repair the damage. Depending upon the procedure to be done, an open surgical procedure may be contemplated, where an incision is made into the joint area to allow the repairs to occur.
Early surgery may be offered to athletes who may want an earlier potential return to play.
Chronic Rotator Cuff Tear
- Pain control usually is the goal of treatment. This can be accomplished with rest and acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
- Physical therapy and range-of-motion exercises may be helpful with a goal of maintaining shoulder function and strength.
- Steroid injections (betamethasone, methylprednisolone) into the shoulder joint may be helpful to decrease inflammation within the area.
- Patients who continue to have pain and loss of shoulder function may benefit from a referral to an orthopedic surgeon to discuss surgical rotator cuff repair.
- Apply ice to decrease swelling.
- Anti-inflammatory medications like ibuprofen and naproxen may help reduce pain and swelling.
- A sling may help support the arm rest the rotator cuff muscles. Long-term use of a sling is not advised, since it may cause significant stiffening of the shoulder joint, or a frozen shoulder, with complete loss of motion.
- Usually, acute rotator cuff injuries require more than one visit to the health-care provider and may also require referral to an orthopedic specialist for advice and care. Surgery may be considered within a few weeks, especially in younger, active patients, to return the shoulder to full function.
- Indications for surgical treatment include the following:
- Usually for patients younger than 60 years of age
- Complete rotator cuff tears
- Failure of conservative therapy (physical therapy, rest, and anti-inflammatory medications) after six to eight weeks
- Employment or sporting activity that requires constant shoulder use
- The type of surgery depends on the extent of damage to the rotator cuff and the appearance of the shoulder joint. If the tendon damage is extensive and cannot be repaired, other options and alternatives, including tendon transfer surgery, might be explored.
- Beginning care
- 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 anti-inflammatory medicines such as ibuprofen or naproxen.
- More severe cases
- Use the techniques described for beginning care.
- Corticosteroid injections into the shoulder joint may be considered.
- After a few days, ice may be alternated with heat and massage therapy and range-of-motion exercises initiated.
- 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 called pendulum exercises).
- Holding a broom with both hands and moving it in a large arc while relaxing the affected shoulder can passively stretch the soft tissues.
Medically Reviewed by a Doctor on 8/31/2017
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