Management of Rotator Cuff Injuries and Adhesive Capsulitis

Initial Management

The American Academy of Orthopaedic Surgeons recommends starting with physical therapy combined with NSAIDs and considering a single corticosteroid injection for short-term pain relief in rotator cuff injuries, while prioritizing multimodal rehabilitation with manual glenohumeral mobilizations, stretching exercises, and considering radial shockwave therapy or cryotherapy for adhesive capsulitis 1, 2

The American Academy of Orthopaedic Surgeons suggests beginning supervised physical therapy immediately, as strong evidence demonstrates that patient-reported outcomes improve with physical therapy in symptomatic patients with full-thickness rotator cuff tears 1, 2
Supervised physical therapy is superior to unsupervised home exercise for rotator cuff pathology, with moderate evidence supporting its use 3
A single corticosteroid injection with local anesthetic can provide short-term improvement in both pain and function, supported by moderate evidence 2
The American Academy of Orthopaedic Surgeons advises against multiple steroid injections, as consensus opinion indicates they may compromise rotator cuff integrity and affect subsequent repair attempts 3

Tear size, muscle atrophy, and fatty infiltration may progress over 5-10 years with nonsurgical management alone, highlighting the importance of regular monitoring 1, 2
MRI, MR arthrography, or ultrasonography can be used as adjuncts to clinical examination for identifying rotator cuff tears 1, 2

Early surgical repair after acute traumatic injury is an option, particularly within 3 weeks of injury, according to the American Academy of Orthopaedic Surgeons 5
Healed rotator cuff repairs show improved patient-reported and functional outcomes compared with physical therapy alone and unhealed repairs 1, 2

The American College of Radiology recommends not delaying imaging when clinical suspicion is high, as early diagnosis guides appropriate treatment timing 6, 1
The American Academy of Orthopaedic Surgeons advises against multiple corticosteroid injections that compromise tissue integrity 3, 4
It is essential to consider labral tears, which require different management, and not assume all shoulder pain in trauma is rotator cuff injury 7