Conservative Treatment and Rotator Cuff Tear Progression

Longo, Umile Giuseppe; Franceschi, Francesco; Berton, Alessandra; Maffulli, Nicola; Droena, Vincenzo

doi:10.1159/000328910

Cited by 56 publications

(44 citation statements)

References 113 publications

(103 reference statements)

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“…23 In primary health care the early diagnosis of a clinically significant medium or large rotator cuff tear, prior to loss of tissue viability is therefore important to inform decisions regarding conservative or surgical management and to optimize surgical outcomes. 24,25 In primary care practice, the clinical diagnosis of rotator cuff tears begins with a clinical examination. The majority of previous studies have estimated the diagnostic accuracy of a small number of physical examination tests for identifying rotator cuff tears.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Cadogan

McNair

Laslett

et al. 2013

Journal of Manual & Manipulative Therapy

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Objectives: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Methods: Participants were consecutively recruited from primary health care practices (n5203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P,0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. Results: A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86-1.00; negative likelihood ratio: 0.00, 95% CI: 0.00-0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86-0.95; positive likelihood ratio 4.66, 95% CI: 2.34-8.74). Discussion: Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Cadogan

McNair

Laslett

et al. 2013

Journal of Manual & Manipulative Therapy

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“…The described successful rate of conservative treatment according to Longo UG et al study varies widely from 33 to 92% [17] .…”

Section: Discussionmentioning

confidence: 99%

Exercise Therapy for Total Tear of Rotator Cuff: A Case Report

Nejati¹,

Akbari²

2013

Asian J Sports Med

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“…We found similar clinical results, with over 76% overall noting an improvement in pain. Another study reported a wide variation of success – from conservative management that included physical therapy, injections, and systemic pharmacotherapy – of 33% to 92%, in patients with shoulder pain secondary to rotator cuff tear 18. Clinical and patient predictors identifying those most likely to benefit are scarce,19 forming an area of much-needed research and insight.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study

Syed¹,

Reed²,

Poterucha³

et al. 2013

IJGM

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BackgroundMusculoskeletal joint pain of varied etiology can be diagnosed and treated with joint and soft-tissue corticosteroid injections.PurposeThe purpose of our study was to compare patients’ bodily pain and quality of life (QOL), in addition to the procedural benefit and patient satisfaction, before and after musculoskeletal injections in the office setting.Patients and methodsPatients were eligible for recruitment if they were over age 18 and had an injection for musculoskeletal pain from a primary care provider in an office procedural practice. Included in our analysis were knee joint/bursa, trochanteric bursa, and shoulder joint/bursa injection sites. The variables measured were pain, benefit from the injection, QOL physical and mental components, and patient satisfaction. This was a retrospective cohort study approved by the institutional review board.ResultsPatients’ pain was assessed by the patients using a six-point Likert scale (none, very mild, mild, moderate, severe, and very severe). We noted that self-perception of pain decreased from 3.10 (± standard deviation at baseline 0.96) before to 2.36 (± standard deviation after the infection 1.21) (P = 0.0001) after the injection. In terms of the impact on QOL, our patients had a pre-injection physical score of 37.25 ± 8.39 and a mental score at 52.81 ± 8.98. After the injections, the physical score improved to 42.35 ± 9.07 (P = 0.0001) and the mental to 53.54 ± 8.20 (P = 0.0001) for the overall group. Ninety-six percent of the patients reported they were satisfied or extremely satisfied in the procedure clinic.ConclusionIn this study, we found significant pain relief and improved physical QOL in patients undergoing an injection in the knee joint/bursa, shoulder joint/bursa, or trochanteric bursa by primary care providers in the office setting.

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Conservative Treatment and Rotator Cuff Tear Progression

Cited by 56 publications

References 113 publications

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

Exercise Therapy for Total Tear of Rotator Cuff: A Case Report

Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study

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