Management of the Irreparable Rotator Cuff Tear

Gregory L. Cvetanovich, MD; Brian R. Waterman, MD; Nikhil N. Verma, MD; Anthony A. Romeo, MD


J Am Acad Orthop Surg. 2019;27(24):909-917. 

In This Article

Nonsurgical Treatment

Nonsurgical treatment is used as the first-line treatment for patients with irreparable rotator cuff tear and can be successful in many patients, although there may be significant progression of tear size, fatty infiltration, and rotator cuff arthropathy.[14] Nonsurgical treatment involves physical therapy to strengthen and re-educate the deltoid, remaining rotator cuff tissue, and the periscapular musculature.[23] Typically, we recommend a supine deltoid reactivation program to determine whether elevation can be restored.[23] NSAIDs and subacromial corticosteroid injections can also reduce pain and improve function, while also allowing more accurate assessment of active and passive range of motion in the absence of pain. Nonsurgical management is favored in patients with lower functional demands, those who are poor medical candidates for surgery, and those with relatively mild pain and mild shoulder dysfunction. Some patients with poorly compensated force couples resulting in clinical pseudoparalysis may improve with nonsurgical treatment as well,[15] although many will go on to elect surgical treatment in our experience. Although anterior deltoid re-education has been explored as a potential treatment, recent results indicate only 40% success.[23]