Operative vs. Non-Operative Treatment of Rotator Cuff Tears

The Rotator cuff is a group of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. These muscles originate at at the shoulder blade and attach to the head of the humerus. These muscles work together to maintain the desired position of humeral head on the glenoid, the articular surface of the shoulder blade. If the rotator cuff is not functioning properly, a simple maneuver like lifting your arm over your head will result in increased stress on the structures associated with the shoulder complex.

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Rotator cuff tears can lead to progressive degenerative changes of bone, tendon, and cartilaginous structures of the shoulder joint causing pain and disability. People with rotator cuff tears are met with a decision to treat surgically or conservatively. While surgery may seem like the only option to decrease symptoms and improve function nonoperative treatment has also shown favorable outcomes. In a 5 year follow up study of operative vs nonoperative treatment of rotator cuff tears researchers compared strength, range of motion, functional performance, need for future surgery, tear progression, and tear size between each group.

The Results:

1. No difference in the strength and range of motion assessment between groups

2. No difference with the functional performance comparison

3. Operative treatment did not decrease the likelihood of recurrent tears

4. Non-Operative treatment was associated with a larger tear size

5. Operative Treatment was associated with less risk for future surgery.

The results of this study clearly show that the subjects had equal strength, range of motion and functional ability regardless of whether they had surgery, or not. The non-operative group showing a larger tear size is expected, being that the goal of surgery is to reduce that tear size. The operative group showing less risk for future surgery, is also an expected outcome, as there are certainly circumstances that require surgery.

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When rotator cuff tears occur, it is often the result of an underlying mechanical dysfunction placing increased stress on the cuff, leading to failure of the tissue. Repairing the tear itself does not fix the cause of the injury. Addressing the mechanical dysfunction is the best way to increase the functional capacity of the shoulder joint, improve overall health and longevity, and reduce the chance of injury.

A rotator cuff repair is necessary in certain circumstances. However, there are many situations where surgery is not the best option. Deciding the best intervention for a rotator cuff tear should be a collaborative decision between the patient, physician, and therapist. Regardless of whether surgery or non-operative treatment is selected, it is imperative deficits in strength, range of motion and control are addressed in all structures involved in proper shoulder function. i.e. your whole body.

-Tiara Dunson, PT, DPT

Chalmers, P. N., Ross, H., Granger, E., Presson, A. P., Zhang, C., & Tashjian, R. Z. (2018). The Effect of Rotator Cuff Repair on Natural History. JBJS Open Access,1. doi:10.2106/jbjs.oa.17.00043

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