Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study

Abstract

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

Orthopaedic Manual Physical Therapy for Shoulder Pain and Impaired Movement in a Patient With Glenohumeral Joint Osteoarthritis: A Case Report

“…This treatment frequency is consistent with that reported in randomized controlled trials of manual physical therapy intervention, which typically involve 1 to 2 sessions per week for a total of 6 to 10 treatment sessions. 1,4,16,43,51,53 In a large, multicenter randomized controlled trial, a treatment plan similar to the one used in this case report was shown to be costeffective compared to usual care by a general practitioner in patients with knee and hip OA. 41 A unique aspect of the plan of care was the incorporation of booster sessions.…”

“…4,19,28 An orthopaedic manual physical therapy approach, which combines manual physical therapy and reinforcing exercise tailored to the individual patient, has been shown to decrease pain and improve function in patients with subacromial impingement syndrome, atraumatic rotator cuff tears, and primary acromioclavicular joint pain. 4,5,21,24,29,43 In a recent pragmatic randomized controlled trial, patients with unilateral subacromial impingement syndrome, treated with either manual physical therapy or a corticosteroid injection, demonstrated significant improvements in pain and function that persisted at 1 year. 43 To our knowledge, peer-reviewed evidence supporting physical therapy intervention in the management of GHJ OA is absent.…”

Complete Rotator Cuff Tear: An Evidence-Based Conservative Management Approach

“…Future studies should further investigate this exercise program. Kuhn et al [55] conducted a multi-centre prospective cohort study of 381 patients who underwent physiotherapy over a 12-week period with a 2-year follow-up. The patients' compliance diaries showed a variation in programs from no therapy to supervision and home, home only, and supervision only.…”

“…Kuhn et al [55] conducted a study over a 3-month period and found that physiotherapy significantly improved pain, function and ROM. Wirth et al [95] conducted a similar study of 60 patients, with a 2-year follow-up.…”

Not the Last Word: Choosing Wisely

“…Surgical treatment may help on both counts. Nevertheless, three out of four patients with degenerative tears do well without surgery [27]. Choose wisely.''…”