Symptomatic rotator cuff tears are a common source of shoulder pain and functional impairment. The evidence-based first-line protocol addresses both the immediate symptom burden and measurable functional outcomes through a structured combination of interventions.
The first-line protocol includes a structured physical therapy programme alongside a single subacromial injection-based intervention for short-term pain and function benefit. The complete selection criteria, sequencing, and clinical decision points are detailed in the full protocol.
Strong evidence supports that both physical therapy and operative treatment result in significant improvement in patient-reported outcomes for patients with symptomatic small to medium full-thickness rotator cuff tears.
Moderate evidence supports the use of a single injection of corticosteroids with local anesthetic for short-term improvement in both pain and function for patients with shoulder pain.
Both physical therapy and operative repair groups demonstrated clinically meaningful improvement from baseline in the Constant score, ASES score, SF-36 score, and strength.
It showed an advantage in favor of injections with improvement in pain and functional scores for up to 12 weeks following the injection.
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