Rotator cuff injuries are one of the most common reasons patients seek care for their shoulder pain. Injuries range from less severe cases of impingement and rotator cuff tendinopathy to more severe injuries such as rotator cuff tears. These tears can be either traumatic or atraumatic in nature depending on the patient’s history. Previous research on patients with rotator cuff tears have found no significant differences between Physical Therapy and surgical interventions for atraumatic and traumatic tears.

Physical Therapy or surgery are not the best option for all patients and each patient should be given an opportunity to pursue non surgical options before surgery. Nevertheless early surgery may still be recommended to some patients in an attempt avoid further retraction of the injured tendon, despite evidence to the contrary, and protect the joint from future arthritis. A recent randomized controlled trial detailed the presence of joint arthritis after being assigned to either conservative or surgical care for a rotator cuff tear.

Kukkonen and colleagues randomized 180 patient with painful, non traumatic small supraspinatus tears to one of three treatment groups.

• Physical Therapy

• Sub Acromial Decompression and Physical Therapy

• Rotator Cuff Repair, Decompression, and Physical Therapy

Patients were followed up to an average of 6.2 years after assignment to their treatment group. They reported only 10 total shoulders cross over from the more conservative treatment groups into the rotator cuff repair group. Authors reported no differences in pain, patient satisfaction, or disability between the groups. Further, authors found surgical repair was not better than conservative treatments on progression of shoulder arthritis between groups.

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