These authors compared the time to achieve clinically meaningful reduction in shoulder pain and function after treatment of rotator cuff tears for 96 patients who underwent nonoperative treatment and 73 patients who underwent a surgical procedure.
Patients were typically 61 years of age, 50% female, 50% smokers, had a duration of symptoms of 20 months, 66% had full thickness tears, and 36% had more than one tendon torn (i.e. supra + infra).
Comment: In this population of patients who had had almost two years of symptoms prior to treatment, there was substantial improvement with non-operative management in 3 months. Thus it seems most reasonable to initially offer this inexpensive approach that does not require down time to protect a repair or time off work. If this does not produce the desired result, surgical approaches can be considered.
The maximum difference between groups in achievement of the MCID for the SPADI scores was at 3.25 months, favoring the nonoperative treatment group. The probability to achieve the MCID was 0.06 (95% confidence interval [CI], 0.00 to 0.12) for the surgical treatment group compared with 0.40 (95% CI, 0.29 to 0.50) for the nonoperative treatment group.
The differences for >30% reduction in SPADI and ASES scores and the MCID for ASES scores were not significant.
Comment: In this population of patients who had had almost two years of symptoms prior to treatment, there was substantial improvement with non-operative management in 3 months. Thus it seems most reasonable to initially offer this inexpensive approach that does not require down time to protect a repair or time off work. If this does not produce the desired result, surgical approaches can be considered.
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