Rotator Cuff Tears: Non Operative Treatment   



- See: partial rotator cuff tear

- Discussion:
    - rotator cuff anatomy
    - frequency of tear
    - diff dx of cuff tears: (partial rotator cuff tear)
    - etilogy of tear:
            - impingement syndrome: (75%)
            - shoulder instability (anterior or multi-directional) (15%) (should be considered in any young active patient);
            - trauma:
                   - occurs in 10% of patients;
                   - note that a displaced greater tuberosity frx is a RTC tear equivolent;
    - functional considerations:
             - references:
                    - Subacromial Injection Improves Deltoid Firing in Subjects with Large Rotator Cuff Tears.
                    - Differences in muscle activities during shoulder elevation in patients with symptomatic and asymptomatic rotator cuff tears: analysis by positron emission tomography.
                    - Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion: A study in cadavera
                    - Symptomatic rotator cuff tears show higher radioisotope uptake on bone scintigraphy compared with asymptomatic tears.


- Shoulder Exam:
    - impingement sign and test
    - it is essential to document ROM deficits, since rotator cuff repair would not be expected
            to yield a good outcome in the face of fixed shoulder contractures;




- Radiographic Findings:
    - scapular outlet view
    - 30 deg caudal tilt view AP view
    - arthrography
    - MRI of Shoulder: Coronal Oblique View of Shoulder

               


- Non Operative Management:
    - in the study by Goldberg BA, et al. (2001), the authors documented the functional outcome in a consecutive series of 46 patients;
           - following inclusion criteria:
                  - full-thickness rotator cuff tear seen by ultrasonography, arthrogram, or magnetic resonance imaging;
                  - absence of a Workers’ Compensation claim or previous surgery;
                  - followup of at least 1 year;
                  - election of nonoperative management by the patient;
           - 26 of the tears involved only the supraspinatus, two involved the supraspinatus and infraspinatus, and two involved supraspinatus,
                  infraspinatus, and subscapularis (16 reports did not specify the size of the tear).
           - treatment consisted only of patient education and a home program of gentle stretching and strengthening;
           - at average followup of 2.5 ± 1.6 years, 27 (59%) patients experienced improvement with nonoperative treatment, 14 (30%) patients experienced
                     worsening, and five (11%) patients remained unchanged;
    - references:
            - Nonoperative treatment of rotator cuff tears.
            - Conservative treatment of rotator cuff tears.
            - Results of nonoperative management of full-thickness tears of the rotator cuff.
            - Nonoperative management of full-thickness tears of the rotator cuff.        
            - Outcome of Nonoperative Management of Full-Thickness Rotator Cuff Tears








- Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears

- References

 



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, October 29, 2013 8:00 am