Rotator cuff tears: is non-surgical management effective?

Paul Sealey,Jeremy Lewis

doi:10.1080/10833196.2016.1271504

Abstract

Background: Rotator cuff-related shoulder pain is a common musculoskeletal complaint with an increasing number of people with shoulder pain undergoing surgical repair each year. The relationship between rotator cuff tendon tears and shoulder pain remains equivocal due to the high prevalence of tears in people without symptoms, which suggests that a proportion of people will undergo surgery on tissues not related to their symptoms. As a result there have been suggestions to initially manage atraumatic tears non-surgically.Objectives: The objective of this narrative review was to present current evidence regarding the assessment and management of full-thickness rotator cuff tears.Major findings: To date, three randomised controlled trials have compared surgical with non-surgical management of rotator cuff tears. Outcomes show a small but non-significant effect in favour of surgery. Only one study has looked at long-term outcomes of greater than one year. Overall 129 subjects have completed a course of non-surgical management and therefore low participant numbers may not be sufficient to draw firm conclusions.Conclusions: Current evidence currently supports the consideration of a non-surgical approach in the management of people with shoulder symptoms and identified rotator cuff tears, for a period of time.

Highlights

Shoulder pain remains one of the most common musculoskeletal complaints
Current evidence currently supports the consideration of a non-surgical approach in the management of people with shoulder symptoms and identified rotator cuff tears, for a period of time
Keywords Rotator cuff, shoulder, non-surgical, physiotherapy Funding details No funding was received for this review Disclosure statement: No potential conflict of interest

Summary

Introduction

Shoulder pain remains one of the most common musculoskeletal complaints. It has been estimated to account for approximately 2.4% of all general practitioner appointments.[1] The most common clinical presentation is rotator cuff related shoulder pain.[2] The rotator cuff muscles and tendons add stability to the otherwise mobile gleno-humeral joint. The definitive contribution of these muscles to stability remains uncertain.[2] Tears involving the rotator cuff are common but the relationship between them and shoulder pain is uncertain due to a high prevalence of asymptomatic individuals.[3,4] It has been shown that in people without symptoms the prevalence of tears may be as high as 54% in those above the age of 60 years.[3] the relationship between tears and symptoms is equivocal, there has been a sharp increase in the number of surgical repairs performed. In the United States of America (US) the number of rotator cuff repairs has increased by 141% from 1996 to 2006.5 Due to the poor correlation between tears and symptoms and the uncertainty of the origin of symptoms recommendations have been made for appropriate non-surgical management before considering surgery.[2,6]

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Results

Conclusion