Treatment of Full-Thickness Rotator Cuff Tear Greater Than 3 cm
Full-thickness rotator cuff tears exceeding 3 cm represent a clinically significant presentation with distinct evidence informing management. This protocol addresses first-line care for symptomatic patients in this specific tear-size category.
Clinical scenario
Full-thickness rotator cuff tear greater than 3 cm. High-quality randomised controlled trials have specifically evaluated outcomes in patients with tears of this magnitude, supporting a structured, evidence-based management approach.
First-line approach
First-line management centres on a structured physical rehabilitation programme, with an evidence-supported injection-based option for short-term symptom control.
The complete regimen — sequencing, intervention criteria, and clinical decision points — is contained in the full protocol.
Treatment goals
Primary targets include meaningful improvement in shoulder function (including Constant score) and a clinically relevant reduction in shoulder pain, particularly in the weeks following any injection-based intervention.
References
- Two high quality RCTs reported significant improvement in PROs (UCLA scores, ASES scores, or strength testing) favoring double row repair in patients with >3cm full thickness rotator cuff tears.
- Limited evidence supports the use of dermal allografts to augment the repair of large and massive rotator cuff tears to improve patient reported outcomes.
- Strong evidence supports that patient reported outcomes (PRO) improve with physical therapy in symptomatic patients with 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.
- 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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