Rotator Cuff Injuries Treatable, But Evidence Is Unclear Whether Surgery Is Preferable

Main Category: Bones / Orthopedics
Article Date: 06 Jul 2010 - 2:00 PDT

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Injuries to the rotator cuff are treatable, but it is unclear which treatment option - surgery or nonsurgical treatments such as exercise or medication - is best, according to a new comparative effectiveness report published by HHS' Agency for Healthcare Research and Quality.

Tears to the shoulder's rotator cuff, which is composed of four muscle-tendon units, are common among older adults. Rotator cuff tears can cause significant pain and limit arm motion.

The report, prepared for AHRQ by the University of Alberta Evidence-based Practice Center and published in Annals of Internal Medicine, examined treatment and rehabilitative options for rotator cuff tears. It found that all treatments, either surgical or nonsurgical, result in improvement, but found few differences between interventions. It also did not find evidence indicating ideal timing of surgery.

"Rotator cuff surgery is a viable option for many patients, but, as with any surgery, it is not for everybody," said AHRQ Director Carolyn M. Clancy, M.D. "This report has good news: most interventions work, and each patient should talk to his or her doctor about which option to pursue."

Most older patients who suffer a rotator cuff tear are first treated with up to 3 months of nonsurgical treatment such as pain and anti-inflammatory medications, exercise, and rest. If treatments other than surgery do not work, the rotator cuff may be repaired surgically, using a variety of methods ranging from minimally invasive techniques to an open operation. Patients can then undergo rehabilitation to restore their range of motion, muscle strength, and function following surgery.

Rotator cuff tears also can occur in younger adults, usually as a result of traumatic injury. In such cases they are almost always treated with surgery.

Some doctors have maintained that earlier surgery results in less pain and better use of the shoulder, leading to an earlier return to work and decreased costs; so, patients often face the difficult decision of opting for surgery rather than waiting for nonoperative treatments to work. However, researchers found little evidence that earlier surgery benefits patients.

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears is the newest comparative effectiveness report from the AHRQ's Effective Health Care Program. The Effective Health Care Program represents the leading federal effort to compare alternative treatments for health conditions and make the findings public, to help doctors, nurses, pharmacists and others work together with patients to choose the most effective treatments.

In conjunction with the new report, AHRQ will soon publish plain-language summary guides about treating rotator cuff tears for patients, clinicians and policymakers. Summary guides on numerous clinical topics and other information and background on the Effective Health Care Program can be found here.

Source:
Agency for Healthcare Research and Quality (AHRQ)

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