Evidence-Based Hand and Upper Extremity Surgery

Abstract

The purpose of this study was to compare the 5-year results of small- to medium-sized rotator cuff tears treated with primary surgical repair with the results of a program of physical therapy. Patients assigned to nonsurgical therapy were given an opportunity to cross over to the surgical treatment arm if their condition did not improve after a course or therapy composed of at least 15 treatment sessions. Eventually, 24% of patients in the nonsurgical treatment arm underwent surgical treatment and were assessed with the physical therapy group. Findings indicated that primary surgical treatment outcomes were better than for physical therapy alone or for surgical treatment after a failed course of nonsurgical treatment. However, the differences were small and below the minimally clinically important difference for the 2 main outcome measures: the Constant score and the American Shoulder and Elbow Surgeons score. The authors concluded that these tears could be managed with therapy as a primary treatment with surgical treatment considered if symptoms failed to resolve. They cautioned that nonsurgical treatment is associated with extension of the tear in 37% of cases and that these larger tears have a poorer outcome after surgical treatment.