February 15, 2011 (San Diego, California) — A physical therapy program can effectively treat most patients who present with atraumatic full-thickness rotator cuff tears and shoulder pain, without the need for surgery, researchers announced at the American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting.
“Our non-operative program is successful in over 90% of patients and the effect seems to last at least 2 years,” John E. Kuhn, MD, associate professor and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee, and director of the Multicenter Orthopedic Outcomes Network (MOON) Shoulder Group, said.
In the United States, at least 10% of persons over age 60 years, or nearly 6 million people, will develop a rotator cuff tear.
Prospective Cohort Study
The study included 396 patients age 18 to 100 years who had atraumatic full-thickness tears documented by magnetic resonance imaging and no other abnormality. The primary symptom was pain in most patients.
Patients were assigned to a physical therapy program that included daily postural exercises, active-assisted motion, active training of scapula muscles, and active range of motion, along with anterior and posterior shoulder stretching. They also performed thrice-weekly rotator cuff and scapula exercises. The program has been shown to be effective in patients with impingement syndrome.
Study participants also did manual mobilization exercises with assistance from a therapist.
Patients returned at 6 and 12 weeks. At this point they could decide that 1) treatment was successful and they needed no formal follow-up, 2) they had improved but would like to continue therapy with scheduled reassessment in 6 weeks, or 3) nonoperative treatment had failed and they would undergo arthroscopic rotator cuff repair.
Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit.
Improvements on Multiple Outcome Measures
Six-week data indicate that fewer than 10% of patients had decided to undergo surgery.
Of patients in whom follow-up data were available for at least 2 years, only 2% had opted for surgery.
The analysis also revealed that patients who decided to undergo surgery generally made their decision within 6 to 12 weeks of starting physical therapy. In addition, patients did most of their physical therapy at home and usually made only 1 weekly visit to the physical therapist.
Finally, Dr. Kuhn emphasized that the physical therapy program alleviated pain without “doing anything to the tear.” The finding suggests that pain may be a less suitable indication for rotator cuff repair than is weakness or loss of function.
American Academy of Orthopaedic Surgeons (AAOS) 2011 Annual Meeting; Abstract #319. Presented February 15, 2011.
These findings are typical of what I find in my rehab practice. Those clients that do the exercises improve.More