Shoulder Function May Be Maintained with Nonoperative Management of Massive Rotator Cuff TearsRotator cuff tears, tears in the tendons that support and help the shoulder move, are a common injury, brought on by repetitive and/or forceful movements. While many people undergo surgery for massive tears, treatment without surgery may be an option for many. The authors of this study wanted to see how the shoulder itself fared after non-surgical treatment.
The researchers originally enrolled 40 patients into the study of nonoperative management for massive rotator cuff tears. Seven of the patients decided to have surgery because of increased pain and/or difficulty moving the shoulder, 4 patients died before the end of the study, 3 could not have the magnetic resonance imaging (MRI) test for follow up, and 7 refused to have the MRI. That left 19 patients for evaluation. They ranged in age from 54 to 79, with the average age being 64 years. Twelve of the patients were men. Three patients had a gradual development of symptoms and 16 sustained their injury through an accident. Six patients had 2 tears and 13 had 3 tears.
Among the patients, all of the tears were considered to be reparable through surgery or irreparable; 8 patients had reparable tears while 11 had irreparable tears.
Before the study began, the patients underwent a physical exam and standard x-rays of the shoulder, as well as an MRI. At follow-up, anywhere from 30 to 65 months later, the patients underwent the same x-rays and MRI, and a shoulder scoring system called the Constant and Murley. The researchers found that, on the whole, most patients were able to continue with satisfactory shoulder function without having had surgery. Through the x-rays and MRIs, the researchers did find deterioration in the shoulder, but this did not seem to have a big effect on the patients' function. They also found, however, that some of the reparable tears had become irreparable over the study period.
The authors point out that their study was not meant to compare surgery with non-surgery treatment, but to study the actual shoulder to see if there were any physical changes as a result of the nonoperative treatment approach.
P.O.Zingg, MD, et al. Clinical and Structural Outcomes of Nonoperative Management of Massive Rotator Cuff Tears. In The Journal of Bone and Joint Surgery. September 2007. Vol. 89-A. No. 9. Pp. 1927-1934.
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