Physical Therapy Comparable to Surgery for Non-Traumatic Rotator Cuff Tears

July 16, 2014 in STSMPT

A recent research study published in The Bone & Joint Journal finds that both surgery and physical therapy are independently helpful for a common shoulder problem, and that there was no statistically significant difference between the outcomes.  For many, physical therapy will be a good first approach to shoulder problems, both in terms of positive outcomes and healthcare spending.

The shoulder dysfunction in the study was “non-traumatic rotator cuff tears.” The rotator cuff is the group of muscles and tendons that stabilize the shoulder joint.  With so much responsibility in human life and such remarkable capacity for movement compared to other human joints, the shoulder is a frequent site of injury and tearing.  Sometimes the rotator cuff tears after a very obvious injury such as an automobile accident.  However, in middle-aged and older adults, it is also common for the rotator cuff to tear with no obvious injury.  These situations are called non-traumatic rotator cuff tears.  Twenty to thirty percent of people over the age of 60 experience a non-traumatic rotator cuff tear at some point in their lives.

In years past, the popular theory was that the rotator cuff was impinging on the highest bone in the shoulder.  However, our new understanding is that the rotator cuff can start tearing just because the repeated strain of daily use starts to overcome the body’s natural capacity to heal, build, and replace tissues.

In the current research study, a group of orthopaedic surgeons divided 180 shoulders with non-traumatic rotator cuff tears into three groups: (1) physical therapy, (2) acromioplasty, and (3) acromioplasty plus arthroscopic rotator cuff repair.  Both the surgical groups also received physical therapy after surgery.  So there’s no getting out of your exercises.  All three groups enjoyed clinically significant improvements, but the differences in positive outcomes between the three groups were slight and not statistically significant.  Only four people in the physical therapy group chose to cross over to the surgery group.  The results of this study show that when you have shoulder problems, especially non-traumatic rotator cuff tears, physical therapy may be a very good first-line treatment option and that a physical therapist should definitely be among the first healthcare professionals you consult.

Resource: Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J. 2014; 96-B: 75-81.

Physical Therapy Rotator Cuff Tears

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