Home

Loading...

Table of contents

Rotator cuff injury

What's new

Updated 2023 CSES guidelines for surgical management of rotator cuff injury.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of rotator cuff injury are prepared by our editorial team based on guidelines from the Canadian Shoulder and Elbow Society (CSES 2023), the American Academy of Orthopaedic Surgeons (AAOS 2020), the American College of Radiology (ACR 2018), and the Italian Society of Muscles, Ligaments and Tendons (ISMuLT 2016). ...
Show more

Classification and risk stratification

Prognostic factors: as per AAOS 2020 guidelines, recognize that:
older age is associated with higher failure rates and poorer patient-reported outcomes after rotator cuff repair
A
higher BMI is correlated with higher retear rates after rotator cuff repair surgery, but no correlation exists between higher BMI and worse patient-reported outcomes after rotator cuff repair
B
the presence of a worker's compensation claim is associated with poorer patient-reported outcomes after rotator cuff repair
A
comorbidities are associated with poorer patient-reported outcomes
B
patients with diabetes will have higher retear rates and poorer QoL and patient-reported outcome scores after rotator cuff repair
B
higher preoperative patient expectations for surgery correlates with higher patient-reported outcomes after rotator cuff repair.
B
Create free account

Diagnostic investigations

Clinical examination: as per AAOS 2020 guidelines, perform clinical examination to aid in diagnosis and stratification of patients with rotator cuff tears.
A

More topics in this section

  • Diagnostic imaging

Medical management

Pain management: as per ISMuLT 2016 guidelines, offer NSAIDs for short-term pain relief in patients with rotator cuff injury.
B

More topics in this section

  • Management of unrepairable tears

Nonpharmacologic interventions

Physical therapy: as per AAOS 2020 guidelines, recognize that both physical therapy and surgical management lead to a notable improvement in patient-reported outcomes in patients with symptomatic small-to-medium full-thickness rotator cuff tears.
A
Show 2 more

Therapeutic procedures

Intra-articular corticosteroid injections
As per AAOS 2020 guidelines:
Consider administering a single injection of corticosteroid with local anesthetic for short-term improvement in both pain and function in patients with shoulder pain.
C
Avoid administering multiple corticosteroid injections as this may compromise the integrity of the rotator cuff and affect attempts at a subsequent repair.
D

More topics in this section

  • Intra-articular hyaluronic acid injections

  • Intra-articular platelet-rich plasma injections

Surgical interventions

Indications for repair: as per CSES 2023 guidelines, perform surgical intervention for traumatic rotator cuff tears within 12 weeks of injury or as soon as reasonably possible.
B

More topics in this section

  • Technical considerations for repair

  • Graft augmentation

Follow-up and surveillance

Postoperative pain management: as per AAOS 2020 guidelines, offer multimodal programs or nonopioid individual modalities to provide added benefit for postoperative pain management after rotator cuff repair.
B

More topics in this section

  • Postoperative rehabilitation

  • Follow-up imaging