July 31, 2013
A pair of new studies indicate that most patients with rotator cuff injuries respond well to non-surgical treatment, and a key predictor of who benefits most from physical therapy may simply be who expects to. This is good news for those coping with rotator cuff injuries, the most common cause of shoulder pain and dysfunction in adults, according to Jeffrey Yormak, MD, FAAOS of Somers Orthopaedic Surgery & Sports Medicine Group in New York.
"Getting the most out of any physical therapy regimen has always depended on the commitment of the patient," says Dr. Yormak, a board-certified orthopaedic surgeon. "Now we know that a can-do attitude plays a huge role in recovering as fully as possible from rotator cuff injuries, which mostly occur in those over age 40 as a result of accidents such as falls or chronic wear-and-tear. This is an important musculoskeletal problem that will only increase in importance as our population ages."
Every year, about 200,000 Americans undergo shoulder surgery related to repairing the rotator cuff, a set of four small muscles in the shoulder that helps to lift and rotate the arm. Much recent research has focused on the optimal treatment for rotator cuff repair - whether anti-inflammatory medication, steroid injections, surgery, physical therapy, or a combination of many options.
New Studies over the MOON
The two new studies from Vanderbilt University Medical Center scientists were done as part of the MOON Shoulder Group, a network of doctors investigating the best options for injured shoulders. The first one, published in May 2013 in the Journal of Shoulder and Elbow Surgery, performed on 452 rotator cuff patients, found that a physical therapy regimen focusing on range of motion, flexibility and strengthening helped 85 percent avoid surgery. Only 2 percent of patients had opted for surgery at the two-year mark, and findings also suggested that pain may be a less suitable indication for surgery than weakness or loss of function.
The second study, presented at the 2013 American Shoulder and Elbow Specialty Day, identified failure predictors for non-surgical treatment of chronic, symptomatic rotator cuff tears in 433 patients, all of whom followed the same rehabilitation program. Patients could declare themselves "cured" and opt to discontinue therapy after six weeks, continue therapy for another six weeks, or undergo surgery. The results showed that the strongest predictor of rehabilitation failure (which occurred in only 20 percent of patients) was patients' expectations of how much they thought physical therapy would work.
Other research on rotator cuff injuries released in the last two years offers a variety of perspectives on repair approaches. A 2012 study, presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, suggests that immobilizing the shoulder and arm for 4 to 6 weeks after surgery - rather than quickly beginning physical therapy - improves healing. Meanwhile, a 2011 study presented at the American Shoulder and Elbow Surgeons meeting, showed that arthroscopic rotator cuff surgery is highly effective, with results remaining excellent five years after the procedure.
"In general, research tends to find little agreement among orthopaedic surgeons on rotator cuff treatment options," explains Dr. Yormak. "Of course, when possible, we always try non-invasive options such as physical therapy before resorting to surgery to help our patients resume normal use of their arms. Though most tears cannot heal on their own, satisfactory function can often be achieved without surgery. Sometimes a specific combination of therapies is required to do the trick."
When to see your doctor
Treatment decisions for individual patients with rotator cuff injuries depend on that patient's specific circumstances and mutual communication between doctor and patient, Dr. Yormak explains. Here are indications you may need to see your doctor for a rotator cuff problem:
"If you've injured your shoulder or experience chronic, lasting shoulder and arm pain, it's best to see an orthopaedic surgeon," Dr. Yormak says. "Only then can you receive a definitive diagnosis and begin treatment. Early diagnosis and treatment of a rotator cuff tear may stop symptoms such as loss of strength and motion from setting in."
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