Algorithm for management of rotator cuff tear

RC: rotator cuff; MRI: magnetic resonance imaging; MR: magnetic resonance; PT: physical therapy.

* It is best to determine which study to perform in consultation with the orthopedic surgeon to whom the patient is likely to be referred.

¶ Subacromial injection of glucocorticoid and analgesic can reduce symptoms and facilitate physical therapy. However, glucocorticoid increases the risk for failed surgical repair; therefore, such an injection should not be given if surgery may be performed within 3 months.

Δ It is reasonable to obtain immediate surgical referral for patients who are heavy laborers who rely on shoulder function for their livelihood or are professional or elite overhead athletes (eg, baseball pitcher, tennis player).