Review Question - QID 219486

The patient sustained an atraumatic, full-thickness rotator cuff tear and elected for non-operative management. Conservative treatment with physical therapy in the setting of atraumatic, full-thickness tears has demonstrated acceptable outcomes, including the avoidance of surgery and significant improvement in patient-reported outcome measures (PROMs; Answer 2).

Rotator cuff tears are common injuries that can be treated without surgery in the overwhelming majority of patients. Full-thickness tears had traditionally been considered a strong indication for surgical intervention. However, physical therapy has more recently been demonstrated as an efficacious treatment strategy for patients with atraumatic, full-thickness tears. Benefits of physical therapy include the avoidance of surgery and improvement in range of motion (ROM) and PROMs among the majority of patients.

Kuhn et al. performed a prospective, multicenter study assessing the efficacy of non-operative management using physical therapy to treat atraumatic, full-thickness rotator cuff tears. Among 452 patients, less than 25% elected to undergo surgery after a trial of physical therapy, there were improvements in average ROM and significant improvements in PROM values across the study population. The authors concluded that physical therapy is a highly effective strategy to alleviate symptoms in patients with atraumatic, full-thickness rotator cuff tears and that approximately 75% of patients treated with physical therapy will avoid surgery at a two-year follow-up.

Kijima et al. presented long-term outcomes of patients with rotator cuff tears treated conservatively at a mean follow-up of 13 years. They found that approximately 90% of patients had no or only slight pain, and approximately 70% of patients had no disturbances with activities of daily living. They concluded that non-operative management is a viable treatment strategy to address rotator cuff tears and that younger patients may experience more significant pain and dysfunction in activities of daily living with conservative treatment at long-term follow-up.

Figure A is a proton-density fat-saturated coronal MRI slice demonstrating a full-thickness supraspinatus tear with tendon retraction.

Incorrect Answers:
Answer 1: In this scenario, physical therapy has demonstrated improvements in ROM, particularly with forward elevation.
Answer 3: Approximately 75% of patients avoid surgery at two-year follow-up with conservative treatment of atraumatic, full-thickness rotator cuff tears.
Answer 4: The majority of patients with rotator cuff tears treated conservatively have minimal pain that does not interfere with activities of daily living at long-term follow-up.
Answer 5: The aim of physical therapy is not to promote tendon healing but rather to strengthen the surrounding, uninjured musculature to provide compensated stability and function at the shoulder joint.