Conservative Management of a Traumatic Rotator Cuff Tear in a Patient With Multiple Comorbidities: A Case Study

Abstract

BACKGROUND: Rotator cuff pathology is quite common in older adults, but traumatic rotator cuff tears are seen less frequently. The multifaceted nature of rotator cuff tears can make intervention selection challenging. This is especially true for high complexity patients with multiple comorbidities. CASE PRESENTATION: An elderly female presented with right shoulder pain, active range of motion deficits, and weakness after a fall on an outstretched hand 3 weeks prior. Examination findings pointed toward a likely full-thickness rotator cuff tear. Balance testing also indicated that the patient was a significant fall risk due to balance deficits. The patient also had many comorbidities, such as poorly controlled type II diabetes, that restricted invasive treatment options. OUTCOME AND FOLLOW-UP: Right shoulder active range of motion and strength greatly improved over the 14 weeks the patient was in physical therapy. Her self-rated disability greatly decreased during this time. These improvements were maintained at the 6-month follow-up. The patent continued to report falls, but at a reduced rate postdischarge from physical therapy. DISCUSSION: The outcomes of this case report suggest that there are potential benefits of individualizing established and evidenced-based protocols. The multicenter orthopaedic outcomes network (MOON) exercises were the basis of her rehabilitation. It was modified to the patient's specific capabilities and needs throughout her plan of care. JOSPT Cases 2022;2(4):181–188. Epub: 17 October 2022. doi:10.2519/josptcases.2022.10990