By: Dr. Daniel Chillianis, PT, DPT
As a nation with an aging population, chronic and degenerative conditions have come to the forefront across all walks of healthcare. It seems everyone nowadays knows at least one person who has heard the unfortunate diagnosis of a “Rotator Cuff Tear”. Upon hearing this, it’s only human nature to assume “Well if it’s torn I have to have it surgically repaired or it’s not going to work again” Right? Well the answer is not as cut (no pun intended) and dry as it seems.
What is the Rotator Cuff?
- The Rotator Cuff is formed by 4 Muscles and their tendons that run from our scapula (shoulder blade) to our humerus (upper arm) and works to provide movement and dynamic stability to the shoulder girdle.
- The Shoulder joint itself is unstable by design allowing for us to use our upper extremities through vast ranges of motion in multiple planes furthering the required need for stability!
- The Rotator Cuff in tandem with our static stabilizers (ie. Labrum, Ligaments, Joint Pressure) further allow us to efficiently perform these motions and tasks while maintaining a stable “happy” shoulder joint.
What is a degenerative rotator cuff tear?
- A degenerative rotator cuff tear is a tear in the shoulder that occurs over time due to aging and wear and tear. It's the most common cause of shoulder pain and is more likely to occur in people over 40.
- The word degenerative is used to signify the absence of a traumatic event causing the injury to the shoulder (Ie. Fall, Sport Activity, Overload Failure) further explaining that “I’m not sure what caused my shoulder to start hurting but it kind of came on one day and then has been getting worse”-type of injury.
Why?
- Bone Spurs
- Decreased blood flow and reduced healing capacity
- Repetitive overhead stress (ie. painters)
Do I need surgery to regain use of my arm and control pain?
- Simply put, “It Depends” and decision requires a comprehensive orthopedic evaluation and physical examination that coordinates with current presentation/limitations and patient-derived goals for use of the involved arm.
Variables include:
- Partial vs. Full Tear
- Comorbidities
- Type of Tear and Muscles involved
A 2021 systematic review of the most current research regarding this decision making helps shed some light on the available options and short/long-term results following:
- There was NO SIGNIFICANT DIFFERENCE in Constant-Murley Score (evaluating shoulder function) between surgical or conservative repair groups at 1 or 2 years after intervention
- The surgical group had statistically lower pain scores (1 point lower) at 1 year after intervention but unlikely to be clinically significant
- OVER ONE-THIRD of those included in the surgical group had a re-tear at 1 year follow up
- 27% of the patients treated conservatively required surgery at 10 years follow-ups
Consensus:
In clinical trials, nonsurgical and surgical management generally have yielded similar outcomes for patients with partial-thickness tears. But for those with full-thickness tears, a few trials have shown better outcomes with surgery.
*If you have a rotator cuff tear or injury diagnosis and would a second opinion, request a consultation or evaluation with us here (can be done in person or via Telehealth) https://www.thegrpt.com/events-and-offers
Garibaldi R, Altomare D, Sconza C, Kon E, Castagna A, Marcacci M, Monina E, Di Matteo B. Conservative management vs. surgical repair in degenerative rotator cuff tears: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021 Jan;25(2):609-619. doi: 10.26355/eurrev_202101_24619. PMID: 33577014
Sederqvist S et al. Non-surgical and surgical treatments for rotator cuff disease: A pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021 Jun; 80:796. (https://doi.org/10.1136/annrheumdis-2020-219099
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