Rotator cuff tears result in a range of symptoms that decrease quality of life, as well as a deterioration in shoulder function and a decrease in work productivity, as shown in the present analysis, and a long-term follow-up. In a recent meta-analysis of the available evidence it seems that there is good evidence that patients with rotator cuff tears are worse than their healthy counterparts at 2 years regarding their shoulder function, pain, disability, sleep disturbance, and anxiety.
Only in the case of tears of 2 or more full-thickness tears, repair is the preferred treatment modality. Repair leads to improved functional results, and a high proportion of patients are satisfied with the outcome of their treatment.
Data from a recent study demonstrated that tear strength is highly dependent upon individual intrinsic factors. A variety of different risk factors such as age, occupation, and repetitive activity in sport predispose individuals to rotator cuff tears. Therefore, there is no single etiology, and tear causation should be considered a syndrome.
When physical examination reveals the absence of pain and stiffness in the shoulder, ultrasound is recommended for a clearer visualization of the rotator cuff and a differential diagnosis to exclude other diagnoses. When physical examination data is inconclusive or when ultrasound examination reveals an apparent lesion but a normal physical examination, a magnetic resonance imaging (MRI) is recommended.
Results from a recent paper identifies a variety of rotator cuff tears and methods of treatment ranging from conservative to total repair. It also discusses the best timing for rotator cuff repair to be performed.
Approximately 7% of all adults are affected by rotator cuff tears. These patients frequently complain of pain, muscle atrophy (atrophy of the neck of the humerus and clavicles), and swelling of their shoulder.
With appropriate treatment, people with rotator cuff tears typically have relatively few problems with shoulder pain and stiffness despite persistent atrophy and degeneration of the shoulder. Pain and stiffness in the long term are far more likely when there are signs and symptoms from other shoulder, arm, or shoulder girdle conditions.
The literature suggests the average age with a rotator cuff tear is approximately 50 years old, but in our experience, a majority (over half) of rotator cuff tears are seen in patients <50 years old. The average tear size is approximately 33 mm x 27 mm which is less than the size of a small orange.
The pain and swelling that occur following shoulder surgery is usually relieved by conservative treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and rest. If conservative treatment does not relieve the swelling, surgery may be used to remove the tear from the shoulder. Surgery may also be used if conservative treatment does not work. In some cases, the shoulder is fitted with a biceps tendon transfer and the shoulder stiffness decreases. If the tendon transfer worked, but a second surgery is required to remove the bicep tendon, the tendon transfer could be fitted for a third and final surgery.
Clinical trials were conducted to evaluate the effectiveness of alternative treatments. Trials have been conducted utilizing anabolic steroid injections and physiotherapy for patients with rotator cuff tears. No other trials that examined other treatments have been found. Further research is needed for a more thorough search.
In the twenty years from 1986 to 2006, there has been no major new discoveries for treating rotator cuff tears. There was an increased use of a combination of two or more steroid injections and some use of rotator cuff repair for patients in which repair was considered. A large randomized, blinded, multicenter clinical trial comparing patients in which repair was done and with which the patients were only treated with a shoulder rehabilitation program has not begun.
In the study, patients with subacromial impingement or rotator cuff tears benefited from a subacromial decompressive exercise intervention, and the combination exercise intervention was even more effective than subacromial decompressive exercise. A placebo group that was monitored for at least 6 months demonstrated no additional benefits from this exercise intervention. Overall, the results of the study indicate that subacromial impingement may resolve without intervention (i.e., in the natural history of the condition), but recovery may be more rapid if the patients are given this exercise intervention.