Patient-led rehabilitation in a short immobilization unit has the potential to lead to less chronic, long-term disability in patients with severe rotator cuff tears (type IV).
Although arthroscopic repairs achieved positive medium-term results (about 7 y after surgery) compared to the historical controls, they had slower recovery times and a lower degree of satisfaction than total shoulder arthroplasty. Based on this study and considering a long-term study, rotator cuff tear arthropathy cannot be cured.
The rotator cuff in conjunction with the coracohumeral ligament and the deltoid, tendons, and muscles play a crucial role in the function of the shoulder joint, especially when the tendon is involved. The most common injuries to patients with rotator cuff tears are muscle tears and capsular damage to the rotator interval. Muscle-to-muscle tendinosis and fibrosis are commonly seen after acute partial-thickness rotator cuff tears, resulting in pain and dysfunction.
Results from a recent paper shows a clear relationship between RTA and tears of the rotator cuff and demonstrates the importance of MRI in the assessment of RTA. This is potentially the first study to show an abnormal tear pattern in RTA, which may help to identify those at risk and, ideally, allow earlier treatment.
While less common than tendinitis, chronic RTA may not be as rare as a whole as previously thought, and this disorder may be the most common cause of shoulder pain in the United States. The clinical severity of RTA may not be predicted by the extent of tendon degeneration but may instead be related to the extent of tendon shortening due to inflammation, which in turn is related to patient age and activity level. The diagnosis of RTA is complicated because patients may be predisposed to RTA due to a combination of factors. Therefore, diagnostic algorithms to use in clinical practice are required to better diagnose RTA.
The surgical repair of rotator cuff tear was a common therapy in this series. While long-term studies are required to assess whether the surgical repair improves long-term outcome, surgical intervention is an effective and safe intervention for rotator cuff tear in this series.
The signs and symptoms of shoulder arthritis in patients who have a recent rotator cuff tear are nonspecific. Because signs and symptoms occur more in rotator cuff-than in supraspinatus-injured patients, pain in the shoulder after injury and nonspecific shoulder pain are nonspecific signs of cuff tear.
In a recent study, findings emphasizes the importance of patient-led rehab intervention in combination with other treatment modalities as a successful rehabilitation program for patients with long-standing rotator cuff tendinopathy.
There have been other clinical trials that have utilized patient-led rehab to improve the patient's functional capabilities to return to his/her usual activities after rotator cuff repair. These trials demonstrated the efficacy of patient-led rehab and led to a better outcome in functional scores postoperatively compared to the usual treatment. Patient-led rehab should be recommended as a first-line rehabilitative intervention and should be incorporated in the treatment of rotator cuff tears.
Based on the findings from the review, there is still no definitive treatment for rotator cuff tear arthropathy. However, there are some promising results from small studies showing that some specific exercise programs may be an option for treatment of this condition. Further investigation is needed to verify these results.
At our study site, the prevalence of rotator cuff tear arthropathy is similar to that in the general population. Despite this, previous operative procedures, including suture anchors, may be the cause of rotator cuff tear arthropathy due to trauma and operative surgery. A full understanding of the etiology of rotator cuff tear arthropathy in this population would help reduce the incidence of these injuries.