Rotator cuff tears are a common cause of shoulder pain in both young and older populations. To learn more about the common injuries, what causes them, how they are diagnosed and how they are treated, check out our last blog here. Following a rotator cuff tear, there are two primary pathways of management: conservative or surgical. Traditionally, surgery is the go-to with a tear that doesn’t “heal”, but current research suggests that surgery should not be a first line treatment. So, what’s the best course of management? Well, it depends…not all rotator cuff tears are equal. The location, size and progression of the tear are all relevant, not to mention the patient’s decision on what they want to do! So, it really is a case by case basis.
Partial vs full thickness tear
Rotator cuff tears can be categorised into partial thickness or full thickness tears. Partial thickness tears have a higher chance of healing without surgical intervention. However, in saying that, 73-80% of patients with full thickness tears also do well with conservative management. All atraumatic partial thickness tears should be treated with conservative management for at least 12 weeks before considering surgery. This first line treatment should include progressive exercise therapy, education and other treatments such as manual therapy.
How did the tear occur?
Firstly, when determining the best course of action, the type of injury plays a part in this decision. Atraumatic tears often present with less pain and loss of function compared to a traumatic injury. It is recommended that a traumatic full thickness tear should be assessed for a surgical opinion. This is because early operative treatment appears to be better for tears with a sudden onset of symptoms and poor function (often associated with traumatic full thickness tears).
Other factors that may influence the decision to operate include:
- Age
- Patient goals and desires
- General health (diabetes, occupation, smoking status)
- Failed physiotherapy
- Level of function and pain
When should I consider surgery?
- Significant pain and loss of function after at least 12 weeks of physiotherapy
- Traumatic full thickness tear
- Significant loss of function
Will surgery fix all my problems?
37% of patients have radiographic evidence of full thickness re-tear at 2 year follow-up after surgery to repair a rotator cuff. This may be due to a number of reasons. Poor outcomes after surgery can be influenced by the following factors:
- Very large tears
- Co-morbidities
- Age (elderly)
- Labour intensive occupations
- Non dominant arm
If you’re going to take anything away from this blog, it should be this…
Exercise therapy is the gold standard, first line intervention for rotator cuff injuries. This should be done first for at least 12 weeks before considering surgery for most tears (excluding traumatic full thickness tears). In saying that, surgery IS sometimes required for rotator cuff tears, however this should be determined on a case by case basis with the input of the patient, surgeon and physiotherapist.
For more information, or if we can help you with your shoulder pain, give us a call on (03) 9391-2600 or email info@revivephysio.com.au
