To treat a non-traumatic RTC tear or refer out?

I recently received an email from MedBridge entitled, “The Relevance of the Physical Exam for Rotator Cuff Tears” in my mailbox.

We can all (with good confidence) pick out a full rotator cuff tear but the remaining question that always gets to me: should I treat…or refer out for surgery?  I have two patients on my case load just right now with these clinical findings: all of which do not want to have surgery.

I didn’t write the post so can’t claim the contents BUT it brought up a VERY good study and wanted to make sure my readers got the information too (if you are not signed up for MedBridge.)

It included a study by Kukkoen, et al. Treatment of non-traumatic rotator cuff tears: A randomized controlled trial with one-year clinical results. Bone Joint J 2014;  96-B: 75-81.  Unfortunately I can’t get to the full article, even through an academic source, but here it is summarized: it was a trial that randomized patients with supraspinatus tears between just physical therapy, physical therapy and acromioplasty, or physical therapy, acromioplasty & RTC repair.  The Constant Score was assessed at 3, 6 and 12 months between the three groups.  Here is the conclusion:

These results suggest that at one–year follow-up, operative treatment is no better than conservative treatment with regard to non–traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.

I said this study was VERY good for five reasons:

1. it answers (in research) through a randomized trial a question that I have not been able to answer with confidence…

2. it answers questions inquired by Systematic Reviews in 2007 and 2011.

3. it gives high props for physical therapy 🙂

4. it is in The Bone and Joint Journal…not in a PT journal.

5. ROCK ON physio group!

If you are interested in signing up for continuing education through MedBridge, use my icon to your right or click this link.  Honestly, if you don’t get it through me…I don’t care!…just sign up…great information that should be available to all physical therapists.   I have learned a great deal from the instructors and was able to do it in my tighty whities.

Ha, just kidding no that last part…