Purpose
To assess the effectiveness of a specific non-operative physical therapy program in treating atraumatic full thickness rotator cuff tears using a multicenter prospective cohort study design.
Methods
Patients with atraumatic full thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, co-morbidities, willingness to undergo surgery, and patient related outcome assessments (SF-12, ASES, WORC, SANE score, Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits patients could chose one of three courses: 1.) Cured (no formal follow up scheduled), 2.) Improved (continue therapy with scheduled reassessment in 6 weeks), or 3.) No better (offered surgery). Patients were contacted by telephone at 1 and 2 years to determine if they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6 week, and 12 week outcome scores.
Results
The cohort consists of 452 patients. Patient reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.
Conclusion
Non-operative treatment using this physical therapy protocol is effective for treating atraumatic full thickness rotator cuff tears in approximately 75% of patients followed for two years.
Level of evidence
Level IV, Case Series, Treatment Study
Fellowship-trained, experienced orthopaedic surgeons had good agreement for predicting full-thickness rotator cuff tears and the number of tendons involved and moderate agreement in predicting the involved side of a partial-thickness rotator cuff tear, but poor agreement in predicting the grade of a partial-thickness tear.
Although nonoperative treatment is considered the standard of care for the treatment of Grade I and II acromioclavicular (AC) joint injuries, the treatment of Grade III injuries is controversial. There are as many methods of nonoperative treatment as there are for operative stabilization. Most of the literature represents Level IV evidence with very few Level II and III studies upon which to base decisions. A systematic review of the English-language literature was performed to determine if Grade III AC joint separations are best treated operatively or nonoperatively. Based on limited low-evidence, nonoperative treatment was deemed more appropriate than traditional nonoperative treatments because the results of the latter were not clearly better and were associated with higher complication rates, longer convalescence, and longer time away from work and sport.
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