Chronic, massive, irreparable rotator cuff tears - improvement without surgery.

Nonoperative Treatment of Chronic, Massive Irreparable Rotator Cuff Tears: A Systematic Review with Synthesis of a Standardized Rehabilitation Protocol

These authors conducted a comprehensive review of studies involving clinical outcomes of nonoperative treatment of massive, irreparable rotator cuff tears.

Multiple studies showed significant improvement exceeding the MCID for functional outcome scores following treatment. Several studies demonstrated significant improvements in strength and range of motion. Success of nonoperative treatment ranged from 32-96%. 

Comment: Many options exist for the management of chronic massive irreparable cuff tears.  

By definition, these chronic tears are long standing, so there is no rush to the operating room. 

As this article points out, stiffness is often an important feature of the affected shoulder. This can usually be addressed by gentle progressive home stretching exercises. Here are some of the most effective:

Supine stretch (link)

Table slide (link)

Pulley (link)

Abduction stretch (link)

Cross body (link)

Up the back (link)

Sleeper stretch (link).

These stretches should be carried out multiple times per day with the stretch being held for a slow count of 10. 

Once full comfortable assisted motion has been achieved with the six exercises described above, it's time to work on strengthening, using a simple press-up exercise (link). It is important that the angle of inclination is progressed slowly, assuring that the exercise can be repeated at least 20 times before the angle is increased. 

This simple home program has been successful in restoring substantial shoulder comfort and function for many shoulders that have been referred to us for reconstructive surgery or for a shoulder replacement. 

Finally, it has been demonstrated that the patient's optimism about the success of the non-operative program is a major predictor of its success.

See also this related post: Rotator cuff tears - getting better without surgery.

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