Rotator Cuff, Part 2 – A Research Study Comparing Physical Therapy to Surgery for Degenerative Rotator Cuff Tears
Rotator cuff tears are a common cause of shoulder pain. Acute rotator cuff tears are tears that happen suddenly with some type of injury or trauma. The focus of this article is on degenerative rotator cuff tears – tears that occur gradually over time as we age. The treatment for degenerative rotator cuff tears is controversial – with some being treated without surgery and some treated with surgery.
A study by Kukkonen and colleagues compared the results of physical therapy treatment to two types of surgery commonly used to treat rotator cuff tears (acromioplasty alone and acromioplasty in addition to rotator cuff repair). Recall that there is a bony arch above the rotator cuff tendons and it is thought that friction against this bony arch creates the rotator cuff irritation and fraying. Surgery that includes an acromioplasty cuts part of this bone to allow more space for the rotator cuff tendons. The patients included in the study had to be greater than 55 years of age, have a supraspinatus tear not caused by trauma (a degenerative tear) and have full range of motion of the shoulder. The patients were randomly assigned to 1 of the 3 groups – physical therapy group, acromioplasty group and acromioplasty with rotator cuff repair group. All 3 groups showed improvement and had similar outcomes at follow-up after one year. Only four of the 55 patients (7.3%) from the physical therapy group eventually had surgery. The authors of the study concluded that the primary treatment for non-traumatic rotator cuff tears in older patients should be physical therapy.
Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominin EK, et al. Treatment of non-traumatic rotator cuff tears. A randomized controlled trial with one-year clinical results. Bone Joint J 2014;96-B:75-81.