THE BEST TREATMENT FOR ROTATOR CUFF TEARS
Rotator cuff tears (RCT) are very common. The stated epidemiology varies considerably but probably a conservative estimate would be that around 10% of those over 65 have a RCT.
Evidence base for non-operative and operative modalities is quite poor.
10 things we do know about RCT’s
1) Few patients with RCTs undergo surgery.
Less than 5% of people with RCTs undergo surgery each year. Presumably other people with RCT have no pain now, minimally pain, or have a good result with non-operative treatment
2) Tear size does not predict symptomatology.
There is no correlation between tear size with pain, duration of symptoms or activity levels.
3) Physiotherapy is effective in treating atraumatic RCT’s.
After 6 weeks of physiotherapy most patient’s shoulders will improve to around 70-75% of normal.
Call Helen Potter 08 9 381 6166 In Touch Physiotherapy to discuss treatment options for your Shoulder Pain.
4) Patient expectation about the likely benefit of physiotherapy predicts its effectiveness.
Physiotherapy is not effective in those who do not think that it will work for them.
5) Surgery and physiotherapy have similar outcomes in atraumatic small and medium sized RCTs in the short term (but surgery results in better outcomes at 5 year follow-up)
In one RCT there was no difference in outcomes between physiotherapy, physiotherapy and acromioplasty and rotator cuff repair at one year follow-up.
In another randomized controlled trial of surgery versus physiotherapy for small and medium sized tears (ie large tears were not included) followed up after 5 years
- there was a 10% better outcome with surgery.
- 25% of patients in the physiotherapy group ended up having surgery.
- 40% of patients treated with physiotherapy had an inferior outcome because the tear size increased over time.
6) Patients with large tears should be considered for surgery because they are unlikely to be able to compensate adequately with physiotherapy and because they tend to increase in size over time.
7) Acute traumatic tears are best treated surgically
Large traumatic tears may occur in younger patients and can cause disabling symptoms if not treated early.
8) Re-tears after rotator cuff repair (RCR) are not uncommon but even those patients with re-tear after surgery have an improved outcome compared to the pre-operative state.
9) A healed rotator cuff repair is associated with improved strength compared to those that have re-torn or treated non-operatively
10) Although repairs are expensive there is an economic benefit to surgery
RCR for full thickness tears produces a net societal cost saving for patients <61 years old and greater QALYs for all patients