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Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A RANDOMISED CONTROLLED STUDY OF 103 PATIENTS WITH ONE-YEAR FOLLOW-UP

Authors: S. Moosmayer, G. Lund, U. Seljom, I. Svege, T. Hennig, R. Tariq, and H.-J. Smith

References: J Bone Joint Surg Br 2010 92-B: 83-91.

Abstract:
In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment.

Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p - 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p < 0.0005), for pain-free abduction (difference 28.8°, p = 0.003) and for reduction in pain (difference on a visual analogue scale -1.7 cm, p < 0.0005).


Concluding comments:

"In this study larger treatment benefits in terms of outcome scores after one year were found for surgical treatment of rotator cuff tears compared to physiotherapy. Differences with statistical and clinical significance were demonstrated on different scoring instruments. At the same time, 42 of 51 non-surgically treated patients accepted the result from physiotherapy as their final treatment result, and nine patients with insufficient effect from physiotherapy were treated effectively by secondary surgery. In the short term, both approaches can be considered in the treatment of patients with small and medium-sized rotator cuff tears but better results can be expected after primary surgical repair. "


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