According to the results of a randomized trial published in the May issue of the Annals of Rheumatic Diseases, rotator cuff surgery and rotator cuff exercise have similar outcomes for patients with rotator cuff injuries.
The study states that:
"The anatomical basis for impingement is a mismatch between the structures in the subacromial space…The evidence supporting the superiority of subacromial decompression (surgery) relative to specific rotator cuff exercise has been unconvincing."
The study took place in a hospital setting, where 90 consecutive patients fulfilling a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign, were randomized either to undergo surgery or therapy with specific rotator cuff exercise, to strengthen the shoulder stabilizers and decompressors.
The age range was 18 to 55 years, and symptom duration was between six months and three years. Outcome measures were shoulder function score and a pain and dysfunction score.
Of the 90 patients enrolled, 84 completed 12-month follow-up, including 41 in the surgery group and 43 in the rotator cuff exercise group.
When comparing the healing scores between the group treated with the specific rotator cuff exercise and the group treated with surgery, by measuring actual improvement in pain and dysfunction, the results where staggering.
The healing factor scores of the group which was treated with the specific rotator cuff exercise was 15% better than the group treated with surgery.
In their conclusion, the researchers stated that:
"Surgical treatment of rotator cuff syndrome (including impingement) was not superior to specific rotator cuff exercise". In fact the outcome of surgery was worse.
This study was published in the Medical Research Unit of Ringkjoebing County in Denmark.
Clinical Context:
The incidence of rotator cuff tendonitis in primary care has been described as high, varying from 3.2 to 4.2 per 1,000 person-years in comparison with shoulder pain, which has an incidence of 11.2 per 1,000 person-years.
Rotator cuff disease with subacromial impingement is graded as acute inflammation with tendonitis or bursitis, chronic inflammation, or full rupture.
Treatments are directed at pain control and remedy of the mechanical problem of mismatch between structures in the subacromial space. In primary care, the condition may be managed conservatively with graded physiotherapy, anti-inflammatory medication, or corticosteroid injections.
Surgical treatment consisting of arthroscopic subacromial decompression is being widely adopted, according to the authors, with limited evidence for success compared with specific rotator cuff exercise.
rotator cuff
14 years ago
