Rotator Cuff Syndrome / Tendinitis (Part Three)

Treatment

The goal of treatment is to reduce pain and restore the function of the shoulder. In planning your treatment, the doctor will consider your age, activity level, and overall health.

Conservative Treatment

In most cases, the initial treatment is non-surgical. Although non-surgical treatment may take several weeks to months, many patients experience gradual improvement and return to function.

Rest: The doctor may suggest rest and modifying activities, such as avoiding activities like lifting your arms overhead.

Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.

Physical Therapy: Initially, a Physiotherapist will focus on restoring normal movements to your shoulders. Stretching exercises are useful for improving the range of motion. If you have difficulty bringing your arm behind your back, you may have developed tightening of the shoulder's posterior capsule. In such cases, specific exercises are needed to alleviate pain.

As pain improves, your therapist may start you on a program to strengthen the muscles of the rotator cuff.

Steroid Injection: If treatment with medications and physical therapy does not relieve your pain, an injection of a local anesthetic and a corticosteroid may be helpful. Cortisone is a very effective anti-inflammatory medication. Injection into the Bursa under the acromion can relieve pain.

Surgical Treatment

When non-surgical treatment does not relieve pain, the doctor may recommend surgery.

The goal of the operation is to create more space for the rotator cuff. To do this, the doctor will remove the inflamed part of the Bursa. They may perform an acromioplasty, in which a part of the acromion is removed, the part that plays the role of a hook by rubbing against the rotator cuff. This is known as a subacromial decompression. These procedures can be performed using arthroscopy or open surgery.

Arthroscopy Technique

In arthroscopy, thin surgical instruments are inserted through two or three small punctures around your shoulder. The doctor examines your shoulder through a fibroscope connected to a television device. Using small instruments and a video monitor, the doctor removes soft tissue and bone. In most cases, the front edge of the acromion along with a part of the bursa is removed.

Arthroscopic Repair.	Open Surgery Procedure.

The surgeon may also treat other shoulder problems during this time. These may include arthritis between the clavicle and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon or partial tears of the rotator cuff.

Open Surgical Technique: In open surgery, the doctor will make a small incision at the front of your shoulder. This allows the doctor to see the acromion and the rotator cuff.

Rehabilitation

After surgery, your arm may be placed in a sling for a short period. This allows for early healing. As soon as you are comfortable, the doctor will remove the sling to start exercises and use of the arm.

The doctor will provide a rehabilitation program based on your needs and surgical findings. This will include exercises to regain the range of motion of the shoulder and the strength of the arm. It usually takes 2-4 months to be completely relieved from pain, but it may take up to a year.