This protocol applies to patients with a full-thickness rotator cuff tear who also have a symptomatic acromioclavicular (AC) joint. The presence of concurrent AC joint symptoms defines this sub-population and directly shapes which treatment approach is appropriate and what outcomes are targeted.
The initial management for this presentation involves physical therapy and a single subacromial corticosteroid injection aimed at short-term pain reduction and functional improvement. This escalation protocol applies when those measures fail to produce meaningful gains in shoulder function (Constant score, ASES score), adequate shoulder strength, or sufficient relief of pain beyond the short term.
When conservative management has been exhausted, the structured protocol involves a surgical approach that addresses both the rotator cuff and the acromioclavicular joint simultaneously. The complete treatment algorithm, eligibility criteria, and procedural details are contained in the full protocol.
Success is assessed by rotator cuff tendon healing confirmed on imaging and by clinically meaningful improvement in validated shoulder outcome scores — specifically the Constant score and the ASES score.
Moderate strength evidence supports the use of distal clavicle resection as a concomitant treatment to arthroscopic repair for patients with full-thickness rotator cuff tears and symptomatic acromioclavicular joints.
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