Non-Operative Management of Rotator Cuff Tears

Abstract

Background:The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent.Methods:A selective literature search was performed and personal surgical experiences are reported.Results:Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis. Conclusion:Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.

Nonoperative treatment of five common shoulder injuries

“…Although symptomatic rotator cuff tears are common and affect between 4% and 32% of the general population, the most appropriate therapy is still debatable [ 59 , 75 ]. While there is agreement that traumatic rotator cuff tears should be treated operatively, the treatment choice for atraumatic rotator cuff tears remains unclear [ 38 , 39 ].…”

“…This is mainly due to the fact that the radiological failure rate following rotator cuff repair surgery can be as high as 70% depending on the patient cohort, thus leading to the assumption that nonoperative treatment may be equivalent [ 5 , 8 , 24 , 41 ]. This conjecture is further strengthened by the fact that pain relief and improvement of symptoms do not necessarily go hand in hand with structural healing of the tendon [ 59 ].…”

Recommendations of the Polish Society of Physiotherapy, Polish Society of Family Medicine and the College of Family Physicians in Poland in the scope of physiotherapy in the painful shoulder syndrome in primary healthcare

“…the following factors should be taken into account in therapy planning: age, profession, pain level, initial functional capability and co-existing diseases. proper pain control is important for motivating patients to participate in rehabilitation [18].…”

“…it follows from the research available that the general success ratio of conservative treatment is ca. 75% [18]. Research conducted on cadavers and radiological analyses demonstrated rotator cuff impingement syndrome in at least 10% of people aged 60 in the usa [19].…”

Postoperative Outcome of a New Shoulder Orthesis after Arthroscopic Rotator Cuff Repair: a Prospective, Randomized Observational Study

“…Klassifiziert wird die Rotatorenmanschettenläsion in Abhängigkeit davon, ob es sich um eine transmurale Läsion handelt, welche Anteile der Rotatorenmanschette betroffen sind und wie weit sich der Sehnenstumpf durch die Retraktion der Muskulatur verkürzt hat [5]. Die Indikationsstellung zur konservativen oder operativen Therapie hängt neben der Rupturmorphologie vom Alter, dem Funktionsanspruch und der Compliance des Patienten ab [6]. Prinzipiell stehen für eine Läsion der Rotatorenmanschette das Glätten der Rupturränder, die Erweiterung des subakromialen Raumes und die Rekonstruktion der Sehnenplatte durch Naht bzw.…”