What are the current guidelines for the conservative management of rotator cuff injuries in adults?

Conservative management of rotator cuff injuries in adults includes the following key components:

• Rest: Advise rest during the acute phase of injury, followed by a gradual increase in activity as tolerated within pain limits to avoid disability and improve function.
• Activity modification: Recommend avoiding or modifying activities that exacerbate symptoms, particularly overhead movements and repetitive arm use, to reduce pain and prevent aggravation.
• Analgesia: Start with paracetamol as first-line analgesia. If ineffective, consider oral NSAIDs (e.g., ibuprofen) or codeine, taking into account contraindications and balancing benefits and risks. NSAIDs should be used only if necessary and for a short duration (maximum 2 weeks) during the acute phase. Regular dosing is more effective than as-needed use. Stronger opioids are not recommended for long-term use due to dependence risks.
• Physiotherapy and exercise: Refer for physiotherapy, typically a 6-week course that may be extended if improvement occurs. Physiotherapy should include postural correction, motor control retraining, stretching, strengthening of rotator cuff and scapular muscles, and manual therapy. Exercises should be low intensity, high frequency, and within the patient’s pain threshold.
• Corticosteroid injections: Consider subacromial corticosteroid injections as part of shared decision-making, especially for severe pain or limited progress with conservative treatment. Injections should be administered by trained personnel, often combined with local anaesthetic, and followed by rest of the joint for 24 hours. Potential adverse effects should be discussed with the patient.
• Shared decision-making and follow-up: Management plans should involve shared decision-making with the patient, setting treatment goals and reviewing progress, typically after 2 weeks. Referral to secondary care is advised if symptoms do not improve after 3 months or if there are red flags or severe functional impairment.

These recommendations are based on UK, Dutch, Australian, and New Zealand guidelines and systematic reviews, reflecting best current evidence and expert consensus for primary care management of rotator cuff disorders ¹.