Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective

Mathiasen, Ross; Hogrefe, Christopher

doi:10.1007/s12178-018-9471-6

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…Edwards et al, 12 in their 2016 review of the literature, showed that conservative treatment can be effective in those with small (<1 cm) full-thickness tears, as well as older (>65 years) patients with chronic, full-thickness tears and associated muscle atrophy and fatty infiltration. Mathiasen and Hogrefe 13 suggest a course of conservative therapy for chronic tears in their primary care perspective paper as well. These studies highlight the effectiveness of nonoperative treatment for full-thickness rotator cuff tears.…”

Section: Discussionmentioning

confidence: 99%

Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment

Lo¹,

Denkers²,

More³

et al. 2018

OAJSM

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PurposeThe purpose of this study was to determine the clinical success rate of nonoperative treatment of partial-thickness rotator cuff tears (PT-RCTs), to determine baseline clinical factors predictive of outcome of nonoperative treatment of PT-RCTs, and to determine the imaging outcome of nonoperative treatment of PT-RCTs.Patients and methodsAll patients with a primary diagnosis of a PT-RCT were eligible for inclusion. Seventy-six patients (48 males, 28 females) with an average age of 52±10 years were included in the study. Patients were evaluated using a standardized format including clinical, imaging, and shoulder specific quality-of-life outcomes. Patients were assessed and treated either successfully nonoperatively or consented to undergo surgical intervention of their PT-RCT. Patients treated nonoperatively underwent follow-up by MRI arthrogram.ResultsThirty-seven patients (49%) underwent nonoperative treatment. Logistic regression analysis indicated that the baseline variables of side (dominant or nondominant side involved), onset (traumatic or atraumatic), and thickness of tendon tear (<50% or >50%) were significant predictors of outcome. At a mean 46±7 months of follow-up, nonoperatively treated patients demonstrated a mean American Shoulder and Elbow Surgeons score of 85.1±16.0, and a Simple Shoulder Test score of 10.0±2.5. Overall, 76% of tears treated nonoperatively did not show a tear progression on anatomic imaging. Nine patients (24%) demonstrated tear progression, of which three patients (8%) demonstrated full-thickness tearing.ConclusionNonoperative treatment was utilized in ~50% of the patients and resulted in improved clinical outcomes. Onset, shoulder involved, and thickness of the tear were predictive of the success of nonoperative treatment.

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Section: Discussionmentioning

confidence: 99%

Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment

Lo¹,

Denkers²,

More³

et al. 2018

OAJSM

View full text Add to dashboard Cite

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“…Higher age and a positive Neer test were found to be the most important predictors of rotator cuff tears [2]. Another study found combinations of certain aspects of the history and physical exam led to a greater diagnostic accuracy of rotator cuff tears [3]. Neither of these studies, however, used both ultrasound and MRI nor were components of the physical exam or history found to help guide clinicians in choosing one imaging modality over another.…”

Section: Discussionmentioning

confidence: 99%

“…There is currently no widely agreed upon patient metrics which allow for accurate and timely supraspinatus tendinopathy diagnosis and efficient use of resources [2]. One study showed that a higher age and positive Neer test were important predictors of rotator cuff tear, although the sample size was small [3]. Another study showed certain aspects of the physical exam and history in combination led to the accurate detection of a rotator cuff tear, although only X-ray and ultrasound were used as the imaging modalities [4].…”

Section: Introductionmentioning

confidence: 99%

Development of supraspinatus imaging guidance for primary care physicians with a focus on patient selection

et al. 2020

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Background: Primary care physicians frequently encounter patients with supraspinatus pathology and face a difficult task of managing this subset of patients using limited imaging resources. The purpose of this study was to develop a guidance that could help primary care physicians choose appropriate imaging tests judiciously for patients with suspected supraspinatus pathology. Methods: The imaging reports of one hundred patients who underwent ultrasound and MRI for suspected supraspinatus tendinopathy were retrospectively assessed. The supraspinatus tendon was recorded as intact, partial tear (articular or bursal), or full-thickness tear (focal or complete width). The agreement between imaging modalities was then evaluated using factors such as pathology type and age. Results: There was agreement between modalities in 48/100 patients (Kappa statistic = 0.30). The consistency varied with type of pathology: intact tendons by ultrasound had 55.8% agreement with MRI, partial sided bursal tears 50%, partial sided articular tears 25%, and full-thickness focal tears 33.3%. Full-thickness complete-width tears had a much better agreement with MRI at 90.9%. Age was also significant, with increased disagreement between ultrasound and MRI in patients over 50 years old. Conclusions: Our data showed that ultrasound findings correlated well with MRI in patients under 50 years of age and also in patients with full-thickness supraspinatus tears. We recommend that primary care physicians may consider using ultrasound as the initial test in younger patients and in patients with suspected full supraspinatus tears, based on clinical exam, with MRI as an option for further evaluation to quantify supraspinatus muscle atrophy. These patient selection recommendations will help promote mindful utilization of scarce resources.

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“…12 Pharmacological treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and nonpharmacological treatments, such as corticosteroid injections and physical therapy (PT), have been described in the management of rotator cuff tears, with the goal of reducing pain and physical disability and improving function. 4,17,28,30…”

mentioning

confidence: 99%

Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Agarwalla

Cvetanovich

Gowd

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

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Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective

Cited by 15 publications

References 28 publications

Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment

Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment

Development of supraspinatus imaging guidance for primary care physicians with a focus on patient selection

Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

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