Outcome of Nonoperative Management of Full-Thickness Rotator Cuff Tears

Goldberg, Benjamin A.; Nowinski, Robert J.; Matsen, Frederick A.

doi:10.1097/00003086-200101000-00015

Cited by 161 publications

(110 citation statements)

References 22 publications

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“…Moreover, rotator cuff retears or failures to heal after repair may be more likely in aged patients [1,8]. Given that shoulders of older patients with intact rotator cuffs have better scores than those with full-thickness cuff tears [3], it is important to understand whether full-thickness rotator cuff tear repair is warranted in older patients when their shoulders function well despite untreated tears [11] or even improve with nonsurgical treatment [7]. To date, it is unclear whether older patients with healed full-thickness tear repairs have similar scores as those who have intact rotator cuffs.…”

Section: Discussionmentioning

confidence: 99%

Healed Cuff Repairs Impart Normal Shoulder Scores in Those 65 Years of Age and Older

Fehringer

Sun

Cotton

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background It is unclear whether repaired rotator cuffs heal in older patients and whether the function in those shoulders compares with those of similarly aged patients with untreated tears. Questions/Purpose We questioned whether, in patients 65 years of age and older, shoulders with rotator cuff repairs that remained intact would have Simple Shoulder Test (SST) scores and Constant scores similar to those of untreated individuals with intact rotator cuffs. Methods We retrospectively reviewed 39 patients (42 shoulders) 65 years of age and older in whom 42 fullthickness rotator cuff tears were repaired with a mini open technique. All patients completed SST and Constant scores 12 to 60 months postoperatively; all patients also had ultrasound at those times to assess the status of the repair.These findings were compared with 200 untreated similarly aged shoulders assessed in the same fashion.

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Section: Discussionmentioning

confidence: 99%

Healed Cuff Repairs Impart Normal Shoulder Scores in Those 65 Years of Age and Older

Fehringer

Sun

Cotton

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Non-operative interventions do not appear to provide full recovery of function in all patients with significant pathology or full-thickness rotator cuff tears. [10][11][12] Surgical interventions may therefore be indicated to address ongoing pain and disability related to impingement and damage to the rotator cuff tendons for refractory cases that have exhausted conservative measures. Surgical success in the field of orthopaedics depends on a number of factors.…”

Section: Introductionmentioning

confidence: 99%

Factors Contributing to Failure of Rotator Cuff Surgery in Persons with Work-Related Injuries

Razmjou¹,

Lincoln²,

Axelrod³

et al. 2008

Physiotherapy Canada

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Purpose: Shoulder pain is a major musculoskeletal and economic concern in industrialized countries, with the rate of surgical failure reportedly higher in patients injured at work. The purposes of this study were (1) to examine the prevalence of identifiable causes of rotator cuff surgery failure and (2) to examine the relationship among the existence of these causes and outcome scores, patient expectations, and overall satisfaction. Methods: This was a cross-sectional study of patients who experienced continued impairments following surgical treatment for work-related injuries. The primary outcome was a disease-specific measure, the Western Ontario Rotator Cuff (WORC) index. Patients were categorized into two groups based on the existence of an identifiable reason for surgical failure vs. no reason for failure, as demonstrated by clinical and radiologic investigations and decided upon by a shoulder surgeon and a physical therapist. Analyses included a t-test for independent sample means, linear regression, non-parametric Wilcoxon test, and Fisher's exact test. Results: Thirty-eight consecutive patients were included in the study, and 24 causes of surgical failure were identified in 19 patients (50%). Overall, patients with findings of failure were more disabled according to the total WORC index and had higher levels of symptoms, emotional difficulties, and limitations in sports and recreational activities. Expectations and satisfaction levels were not significantly different between groups. Conclusion: Our results indicate that 50% of patients who reported failed surgery had at least one reason to explain their ongoing symptoms, emotional difficulties, and functional limitations. 125de symptô mes, de difficulté s é motionnelles et de limitations dans leurs activité s sportives et de loisirs. Les attentes et les niveaux de satisfaction n'é taient pas considé rablement diffé rents entre les groupes. Conclusion : Nos ré sultats indiquent que 50 % des patients ayant signalé un é chec chirurgical avaient au moins une raison pour expliquer leurs symptô mes continus, leurs difficulté s é motionnelles et leurs limitations fonctionnelles.

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“…22) Routine use of subacromial decompression needs to be reconsidered in spite of potential disadvantages of subacromial decompression, including violation of the soft tissue envelope during arthroscopy leading to intraoperative soft-tissue swelling, weakening of the deltoid origin by detachment of some anterior fibers, anterosuperior instability in the presence of a failed rotator cuff or irreparable tear, and formation of adhesions between the raw exposed bone on the undersurface of the acromion and underlying tendon, which in turn can limit smoothness, motion, comfort, and range of motion. 23) The results of the study showing no differences in degeneration between the articular and bursal sides of the rotator cuff tear support these opinions. Limitations of this study include a cross-sectional study that includes the later stage of rotator cuff disease, use of a semiquantitative grading system, only H&E staining, and no evaluation of myxoid, lipoid, or calcific degeneration.…”

Section: ) ‡mentioning

confidence: 59%

Similar Degree of Degeneration in the Articular and Bursal Layers of Delaminated Rotator Cuff Tear

Lee

Shin

et al. 2016

Clinics in Shoulder and Elbow

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Background: The purpose of the study was to compare the degree of degeneration of the articular and bursal layers of delaminated supraspinatus tendons based on histological examination. Methods: Fifty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from the lateral torn edges of the articular and bursal layers of the delaminated tear. Harvested samples were stained with H&E dye and evaluated based on a semi-quantitative grading scale. Results: There were no significant differences in the seven histological characteristics of tendon degeneration: fiber structure, fiber arrangement, round nuclei, regional variations in cellularity, vascularity, collagen stainability, and hyalinization between the articular and bursal layers of the delaminated rotator cuff tear (all p>0.05). Total degeneration scores of articular and bursal sides were 13.1 ± 3.85 points and 13.2 ± 3.42 points, respectively, and were not significantly different (p=0.958). Conclusions: The study demonstrates that tendon degeneration was similar in the articular and bursal sides of the delaminated fullthickness rotator cuff tear, suggesting that degeneration would be a main etiology for the rotator cuff tear not only in the articular side but also in the bursal side. Considering potential disadvantages of subacromial decompression, this study tentatively suggests routine use of subacromial decompression as well as the need for halting or recovery from rotator cuff degeneration for better rotator cuff repair.

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Outcome of Nonoperative Management of Full-Thickness Rotator Cuff Tears

Cited by 161 publications

References 22 publications

Healed Cuff Repairs Impart Normal Shoulder Scores in Those 65 Years of Age and Older

Healed Cuff Repairs Impart Normal Shoulder Scores in Those 65 Years of Age and Older

Factors Contributing to Failure of Rotator Cuff Surgery in Persons with Work-Related Injuries

Similar Degree of Degeneration in the Articular and Bursal Layers of Delaminated Rotator Cuff Tear

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