Your rotator cuff is a group of four strong tendons that connect your humerus to your shoulder blade. As their name implies, the rotator cuff tendons help you move and rotate your shoulder joint, but because the shoulder is less stable than other large joints like your hip or knees, it’s these tendons that oftentimes become damaged when the shoulder is overstressed. When this happens, a rotator cuff tear can develop.
Rotator cuff tears come in all different shapes and sizes, and your specific tear will dictate how your shoulder specialist will proceed with treatment. In today’s blog, we take a closer look at the common treatment regimens for small and large rotator cuff tears.
Treating Small Rotator Cuff Tears
Rotator cuff tears can be classified in a few different ways. Some specialists work with “small” and “large” designations, while others have more definitions based on the specific size of the tear. The standard definition for these types of rotator cuff tears are as follows:
- Small – <1 cm
- Medium – 1-3 cm
- Large – 3-5 cm
- Massive >5 cm
When working with just small and large classifications, oftentimes small and medium sized tears are considered small, while large and massive tears are considered large.
Small tears are obviously preferred to larger tears for a number of reasons, one being that you have some more flexibility when it comes to treatment. Surgery would likely address the problem, but because the tear isn’t compromising as much of the tendon as a larger tear, you may also find that conservative treatments prove effective. Given that effective non-operative care leads to shorter recovery times, lowered costs and a reduced likelihood of the risks associated with surgical correction, it’s easy to see why conservative treatment is preferred for small tears.
Some of the most common treatment recommendations for small rotator cuff tears include:
- Rest/Activity avoidance
- Pain medications/Anti-Inflammatories
- Ice to manage swelling and inflammation
- Gentle stretching/Range of motion exercises
- Physical therapy
- Corticosteroid injections
The most effective treatments will be the stretching routine and physical therapy to restore strength, motion and function in the shoulder complex as healing runs its course, but these active modalities may be easier to pursue with the help of passive care options like rest, ice and anti-inflammatories. Most patients can make a return to normal physical activities and be close to full strength by pursuing these techniques for 4-8 weeks.
Treating Large Rotator Cuff Tears
Larger rotator cuff tears have less flexibility when it comes to treatment. These large tears are unlikely to heal to the point where they can provide ample stability to the shoulder joint, meaning your shoulder will likely feel loose, uncomfortable and be at a heightened risk of another tear or a related issue like a dislocation. The most common treatment for these large tears is surgery.
During the procedure, the surgeon will work to pull the tendons back to the bone and secure them in place with sutures. This can be performed on a minimally invasive or open basis, and is a relatively quick procedure. Following surgery, you’ll need to limit stress on the shoulder area while the tendons heal, so you can expect to wear a sling for the first 4-6 weeks. Physical therapy begins once the sling is removed, and you can expect about six weeks of targeted PT. You’ll likely have decent strength in the shoulder joint around the 3-month mark, but physical therapy, range of motion exercises and stretching techniques may be recommended until you’ve reached full strength, which typically occurs around the 6-month mark.
Whatever type of tear you’re dealing with, we’re confident that Dr. Holloway and his team can provide the right diagnosis and treatment for your specific needs. For more information, or for assistance managing a different shoulder issue, reach out to Dr. Holloway’s office today at (865) 410-7887.
