Rotator Cuff Repair is Not Always the Answer

The rotator cuff is made up a group of muscles and their tendons that surround the arm bone. They help to hold the shoulder joint together and are responsible for proper shoulder joint movement. Tearing of one of the tendons of the rotator cuff results in pain and dysfunction. It is estimated that thirty percent of people over sixty have a non-traumatic rotator cuff tear due to normal wear and tear.

Controversy exists over how to treat these tears. Because non-traumatic tears are often due to faulty joint mechanics, there are several treatment options available. Most conservative is physical therapy for improved muscle balance and joint movement patterns. An acromioplasty is another treatment method which shaves away part of the shoulder blade that tends to fray one of the commonly torn rotator cuff tendons. Finally, there is also the option of surgery to repair the rotator cuff tendon.

A recent study investigated the three main treatment paths for non-traumatic rotator cuff tears. They compared 167 patients with an isolated, non-traumatic tear of the supraspinatus, one of the rotator cuff muscles. Participates all were over the age of 55, had pain, but also had full range of shoulder motion. The patients were divided into three treatment groups: physical therapy only, physical therapy and an acromioplasty, and a rotator cuff repair, acromioplasty, and physical therapy.

The study followed the patients for two years post intervention. At that time, there was not a significant difference in recovery or pain between the outcomes of the groups. MRI follow up did show further gapping of the supraspinatus tendon and degenerative changes in the group that did not receive surgery, however this was not reflected in the patient’s overall outcome. Because of this, authors recommend conservative treatment (physical therapy only) for older patients with a non-traumatic supraspinatus tendon tear.

References: Kukkonen, J., M.D., et al. Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up. The Journal of Bone and Joint Surgery. November, 2015. Vol. 97-A, No. 21. Pp. 1729-1737.

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