Rotator Cuff Tears

Found an interesting bit at MedPage Today.

There are several effective approaches for treating a rotator cuff tear, but none stands above the rest, a systematic review showed.  A literature review revealed that both operative and nonoperative approaches work for improving function and relieving pain, Jennifer Seida, MPH, of the Alberta Research Center for Health Evidence at the University of Alberta in Edmonton, and colleagues reported online July 5 in the Annals of Internal Medicine.

But evidence comparing different techniques was limited and weak, “which precludes firm conclusions for a single approach or the optimal overall management of this condition,” the researchers wrote.

Complication rates across studies were low.

“Because of the low event rates, the benefit of receiving treatment for rotator cuff tears seems to outweigh the risk for associated harms,” Seida and her colleagues concluded from their review, which was prepared for the Agency for Healthcare Research and Quality.

Really?  Getting treatment for a tear is a good idea?  They spent money to figure this out?

Without treatment:  can’t get things out of the cupboard, can’t use a computer’s mouse, can’t wash own hair, can’t dress without assistance, can’t reach overhead, difficult to lift things, can’t play guitar (or violin or piano), can’t help put up hay…

With treatment:  function restored (at least enough to do most routine activities)

It’s really not as obvious as some of the studies Dr. Grumpy reads.  There are risks associated with treatment (even though the article doesn’t say what those risks are).  It’s like taking medicine:  you only want to do it if the potential benefits outweigh the risks.  What they wanted to know is which treatment is best (comparative effectiveness at work?).  The answer is that we just don’t know.  It’s worth reading the entire article:  No Clear Favorite for Rotator Cuff Repair 

With any luck, some poor student in need of a study topic will follow-up and figure out which treatment is most effective.  Not just PT versus surgery, either.  If the answer is PT, I want to know which PT exercises would be best.

I tore my rotator cuff last July.  That’s right – a full year ago.  First I did exercises at home that had previously been prescribed for tendonitis.  They didn’t work.  Eventually I spent hours travelling for treatment only to pay a physical therapist to tell me to do the exact same thing I was already doing.

Since all that work/time/money didn’t help, I wasn’t too optimistic when I was sent back for yet another round of PT.  This time, though, I’ve been given different exercises.  This time it’s working.  I don’t have full use, but enough to do most things.  So why didn’t we start with these exercises instead of spending two months (and blowing my insurance company’s PT allotment) on something that was useless.  It would have been really nice to start with the exercises that work.

I guess that’s the point of the study.  Treatment helps, but it would be nice to know which treatments would be best for a specific tear.

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One thought on “Rotator Cuff Tears

  1. I have a full tear in the right shoulder and a partial tear in the left. Not so much pain in either one and range of motion isn’t an issue because I have ehlers-danlos and that keeps all my joints loose! This was diagnosed about four years ago. The pain was pretty much gone after about six months and gradually over the next year after that, I regained full use. I have to be careful moving my arm certain ways and when I have to lift anything, I use my bicep muscles (they’re really strong now!). I refused surgery because of the ehlers-danlos. Most people want it fixed NOW and do the surgery. I know about 10 people who have had rotator cuff surgery and none of them had good results. With patience, they would have gotten the same result just doing the exercises and waiting it out. Four people I know have ehlers-danlos and ended up having more than one surgery because the “fix” actually made the pain worse. Glad to hear your shoulder is better.

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