Rotator cuff tear: Surgery Vs. Conservative Management
Rotator cuff tears are a common cause of shoulder pain in adults and often occurs without a traumatic injury, but are more of an overuse type injury. People have long since thought that following a rotator cuff tear all roads lead to surgery, however recent research is showing that physical therapy may be a better route, demonstrating similar outcomes and preventing an invasive surgery.
A study done in Finland found that physical therapy may be as effective as surgery for non-traumatic rotator cuff tears. The study looked at 167 patients over the age 55 (mean age of 65) who were diagnosed with a supraspinatus tear. The research was published in the January 2014 (Mossmayer et al, 2014) issue of Bone and Joint Journal and asserted that “conservative treatment should be considered as the primary treatment for non-traumatic rotator cuff tears”. In the study patients were assigned to 3 groups. One group received physical therapy only; another group received an acromioplasty and physical therapy; the third group received a rotator cuff repair, an acromioplasty, and physical therapy. Patients were assessed on the Constant Shoulder Score, which is a scale that is filled out by their clinician and rates pain, range of motion, strength, and activity level. The patients were assessed at 3, 6, and 12 month intervals and compared between groups and the study showed substantial similarities in the patients’ rate of improvement. The original hypothesis for the study was that the patients who underwent a supraspinatus repair would perform far superior to those who received an acromioplasty or conservative treatment alone. Likewise, the patients’ subjective satisfaction ratings were the same for all three groups.
A study done in 2017 (Royosa et al, 2017) demonstrated very similar results with no statistical significance noted in the conservative management group when compared with the surgical group. This study looked at 3 randomized control trials with a total of 252 participants (123 surgical cases and 129 conservative management cases). A 1 year follow-up was done with all participants to assess how their recovery was with their rotator cuff injury. There was a slightly lower report of pain and a slightly higher report of improved function in the surgical group, however the effect size was not statistically significant. Likewise, when compared to the risks and expenses that come with invasive procedures like surgical intervention, the non-surgical approach was found to be the best approach for initial treatment following a rotator cuff tear.
There was one final study that looked at 1, 5, and 10 year follow-ups of patients placed in either surgical treatment or conservative management (Mossmayer et al, 2019). This study looked at 103 patients divided 52 to 51 respectively (mean oage of 60) and followed them over the 10 year time frame. At the 1 and 5 year checks results slightly favored the surgical group, but both were found to be of no statistical significance, however at the 10 year follow-up the results showed that 10 of the 51 patients previously categorized into the conservative management category had undergone surgery, with seemingly good results. This study did demonstrate that conservative management of rotator cuff tears may only prolong the time before requiring surgical intervention, however in the 41 remaining conservative care group members positive results were still reported.
Overall, the general consensus seems to be that early conservative management is advised and if symptoms persist, surgical intervention may be required. This can be dependent on the patient and their specific needs, and also looks at how impaired their daily function is. If you are dealing with shoulder pain and would like to see if physical therapy can help or have a known rotator cuff tear and would like to try and avoid surgery, give us a call today and see if we can help.