Exercise Therapy in the Non-Operative Treatment of Full-Thickness Rotator Cuff Tears: A Systematic Review

Abstract

Background: Although commonly prescribed, the evidence to support exercises therapy (ET) and conservative management for the treatment of full-thickness rotator cuff tears (FTT) is equivocal. Purpose: The purpose of this systematic review of the literature was to determine the current level of evidence available for ET in the treatment of FTT and to provide a formal Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group of recommendation. Methods: Five databases were systematically searched to evaluate the effectiveness of ET for FTT. Inclusion criteria: experimental or observational studies of adults clinically diagnosed with FTT, or massive, or inoperable tears that contained a treatment group that received ET for FTT. Exclusion criteria included: history of surgical repair, concurrent significant trauma, neurological impairment, and level V studies. Articles were assessed for quality, the level of evidence (I-V) and GRADE of recommendation (A to F) was determined. Data extraction included: demographics, specific interventions, and outcomes. Results: One thousand, five-hundred and sixty-nine unique citations were identified, 35 studies were included: nine randomized controlled studies, six cohort studies, 15 case series and five case reports. There were 2010 shoulders in 1913 subjects with an average age of 64.2 years, 54% males, 73% of tears were >1 cm and 37% were classified as massive. Based on studies that reported, >58% of tears were >1 year and 73% were atraumatic. Of the non-operatively treated cohorts that reported the respective outcomes: 78% improved in pain (9/10 cohorts that reported statistically significant differences [stat-sig] p<0.05), 81% improved in ROM (14/14 cohorts that reported, met stat-sig), 85% improved in strength (7/8 cohorts that reported, met stat-sig), 84% improved in functional outcomes (17/17 cohorts that reported, met stat-sig). Dissatisfied outcomes occurred in 15% of patients, who then transitioned to surgery. Conclusion: The current literature indicates GRADE B recommendation (moderate strength) to support the use of ET in the management of FTT. There is further need for well-designed randomized controlled trials.

Correlation between full-thickness degenerative supraspinatus tear and radiographic parameters including the acromiohumeral centre edge angle and the greater tuberosity angle

“…RCTs are one of the most common causes of chronic shoulder pain, leading to decreased functionality, decreased quality of life and increased utilization of health care resources [ 15 ]. Due to its cost effectiveness and accessibility, the standard shoulder series is typically the first line of investigation for patients suspected of having RCTs [ 16 ] to provide additional information and the need for advanced images, such as MRI of the shoulder [ 17 ].…”

Do Acromiohumeral Centre Edge Angle and Greater Tuberosity Angle Correlate With the Full-Thickness Degenerative Supraspinatus Tear?

“…RCT is one of the most common causes of chronic shoulder pain, leading to decreased functionality, declined quality of life and escalated utilization of health care resources (14). Due to its cost effectiveness and accessibility, the standard shoulder series is typically the rst line of investigation for the patients suspected RCT (15) to provide additional information and needs of advanced images as MRI of the shoulder (16).…”

Rotator cuff unloading versus loading exercise program in the conservative treatment of patients with rotator cuff tear: protocol of a randomised controlled trial

“…Degenerative tears in the rotator cuff is a common finding in imaging studies due to the natural ageing process. 4 41 There is evidence that therapeutic exercises should be the first treatment option for these patients 14 because the surgical approach is not clinically superior than the non-surgical approach in this population. 12 Several exercise protocols have been proposed for this population.…”

“… 12 Several exercise protocols have been proposed for this population. 14 However, there is no consensus on which exercises or exercise programs are the most effective. This fact challenges the physical therapist in the clinical decision making.…”