Nonoperative Management: Natural History, Medications, and Injections

The natural history of massive rotator cuff tears is not well known. Nonoperative treatment for patients with massive rotator cuff tears involves a combination of rest, activity modification, medications, physical therapy, and steroid injections. Nonoperative treatment is successful in decreasing pain in a large number of patients in short to midterm follow-up, especially lower-demand patients, but less satisfactory results may be seen in the long term. Patient function with nonoperative treatment is highly dependent on their pretreatment range of motion and function. The addition of steroid injections to the nonoperative treatment approach does seem to offer additional benefit in regard to pain reduction. Nonoperative treatment, however, does not prevent the development of degenerative changes in the glenohumeral joint and tear progression, including an increase in fatty infiltration and muscle atrophy. Therefore, outcomes may deteriorate over time.