A recent study published in the Bone and Joint Journal, demonstrated that when it comes to treatment of non-traumatic rotator cuff tears, physical therapy alone produces results equal to those of arthroscopic surgery and open surgical repair. According to the authors, follow-ups of 167 shoulders treated show that "conservative treatment should be considered as the primary treatment for this condition."
Rotator cuff tears combined with shoulder impingement syndrome is a common condition seen in persons beginning in their 50’s. Symptoms often begin without specific injury and prevent individuals from reaching and lifting overhead due to a painful pinching sensation in the shoulder and upper arm. This pinching is simplistically explained as compression of the rotator cuff tendons and other structures within the space between the acromion (part of the shoulder blade) and the head (ball) of the upper arm bone.
The study was a randomized controlled trial built around treatment of 167 patients aged 55 and older (mean age 65) with supraspinatus tendon tears. This is the most common type of degenerative rotator cuff tear. Patients were assigned to 3 groups: one group received physical therapy only; the second received acromioplasty and physical therapy; and the third group was treated with rotator cuff repair, acromioplasty, and physical therapy. Acromioplasty is the use of surgical tools to shave off bone suspected of creating impingement. Each group contained similar age ranges and equal distribution of men and women.
The methods of physical therapy treatment were the same across groups. Patients were provided with a home exercise program that focused on glenohumeral (ball and socket) motion and active scapular (shoulder blade) exercises for a period of time followed by a further progression of resistive exercises. Participants also were referred for 10 physical therapy sessions in an outpatient clinic.
When patients were assessed at 3 months, 6 months, and 1 year, researchers found substantial similarity in rates of improvement. "Contrary to our hypothesis, surgical repair of a supraspinatus tear does not improve the Constant score when compared with acromioplasty only or conservative treatment," the authors write. Further, the patients' subjective satisfaction ratings were the same for all 3 approaches.
It is interesting to note that, these findings even seemed to contradict the placebo effect which is often associated with surgery. Authors noted that participants were aware of the treatment path assigned to them, yet the surgery group did not report markedly different perceptions of improvement.
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Physical Therapy as Effective As Surgery for Rotator Cuff Tears. PT in Motion. 2014 May:10
Kukkonen J, Joukainen A, Letinen J, et al. Treatment of non-traumatic rotator cuff tears: A randomized controlled trial with one-year clinical results. Bone Joint J. 2014 Jan;96-B(1):75-81. doi: 10.1302/0301-620X.96B1.32168.