The treatment algorithm for a rotator cuff tear depends a lot on the patient: the patient’s age, their activity level, and the degree of the tear. If it’s a partial thickness tear, generally my protocol for that would be to start with a course of rehabilitation – physical therapy, activity modification, anti inflammatories (Ibuprofen, for instance). Perhaps a cortisone injection – a cortisone is an anti-inflammatory – I can inject cortisone into the region where the rotator cuff tear is. That can help settle down the inflammation in the region – it will not heal the tendon. The cortisone is an anti-inflammatory – it will help with the inflammation but it doesn’t heal anything. One common misconception about Corazon actually, (which I hear not infrequently from patients) is that it’s bad for the body. It is true that cortisone (if given too often) can be deleterious to your tissues. But cortisone given appropriately by a medical professional and given not too frequently can be a very helpful adjunct to treating various issues such as rotator cuff tear because it can help settle down the inflammation and help markedly with your pain for some period of time. So a cortisone injection, physical therapy, anti-inflammatories would be the first line of treatment for a partial thickness tear. For a full thickness rotator cuff tear, a lot of it depends on the patient’s age and activity level. If it’s someone who is elderly and not particularly active, if it’s their non dominant arm, then I’d be more likely to try a course of physical therapy and maybe a cortisone injection. If it’s someone who’s 70 but loves playing golf or tennis, and it’s really affecting their quality of life, then I would suggest fixing that surgically because by repairing it, it will allow them to hopefully get back to performing the activities that they enjoy.
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