# Rotator Cuff Disorders: Practical Recommendations for Conservative Management Based on the Literature

## TL;DR

This paper provides a comprehensive, evidence-based protocol for non-surgical management of rotator cuff disorders, integrating diagnosis, prognosis, and rehabilitation.

## Contribution

A new global protocol for conservative management of rotator cuff disorders, stratifying patients into prognostic categories with tailored treatment strategies.

## Key findings

- A stepwise diagnostic process combining history, examination, and imaging is recommended.
- Three prognostic categories (good, borderline, poor) guide treatment adaptation and monitoring.
- Rehabilitation is structured around four domains, including pain control, mobility, strengthening, and anatomy preservation.

## Abstract

Conservative management of rotator cuff disorders remains challenging, with no comprehensive, evidence-based framework integrating diagnosis, prognosis, rehabilitation, and biological therapies. Existing recommendations usually address isolated components of care, leading to inconsistent treatment strategies. This article proposes a global, pragmatic protocol for the non-surgical management of rotator cuff lesions, from initial assessment to long-term follow-up. Drawing on clinical expertise supported by recent literature, we outline a stepwise approach that begins with a comprehensive diagnostic process that combines history, clinical examination, and targeted imaging. Based on lesion type, associated shoulder or neurogenic conditions, and patient profile, rotator cuff disorders are stratified into three prognostic categories under conservative care: good, borderline, and poor prognosis, highlighting factors that require treatment adaptation or early surgical consideration. Rehabilitation objectives are structured around four domains: (1) inflammation and pain control, (2) mobility and scapular kinematics, (3) strengthening and motor control with tendon-sparing strategies, and (4) preservation or restoration of anatomy. For each prognostic category, we define a monitoring plan integrating clinical reassessment, ultrasound follow-up, and functional milestones, including return-to-play criteria for athletes. This comprehensive narrative review demonstrates that precise diagnosis and individualized rehabilitation can optimize medical follow-up, active strengthening, and complementary or regenerative therapies. Aligning therapeutic decisions with prognostic and functional goals allows clinicians to optimize patient satisfaction and recovery, providing a clear, evidence-informed roadmap for conservative management of rotator cuff disorders.