Posts in rotator cuff tear
Physical Therapy Accelerates Recovery From Rotator Cuff Tears
shoulder pain-rotator cuff tear-physical therapy-treatment

Rotator cuff tears are a common finding among middle aged adults with shoulder pain, but are also found among their peers without shoulder pain. Many of us will develop these tears as we age and as we have discussed in previous blog posts there is no difference in outcomes at 1 or 2 years if a patient elects for surgery or Physical Therapy for treatment of their symptoms. Our interventions in Physical Therapy are designed at optimizing shoulder function through manual therapy and strength training exercises allowing patients to return to their prior levels of activity without symptoms. Thankfully many rotator cuff tears improve over time due to the natural history of this injury, but a research study suggests Physical Therapy may accelerate this recovery if utilized early in a patient’s recovery.

Dickinson and colleagues studied 55 patients with rotator cuff tears for up to one and half years after the onset of their symptoms (J Shoulder Elbow Surg. 2019). Patients were broken into two different groups based on their utilization of Physical Therapy interventions. Authors reported patients who received Physical Therapy in the first three months after the onset of their symptoms reported greater improvements in pain and function compared to patients utilizing other interventions such as medication or a wait and see approach. Importantly, Physical Therapy was found most effective in the first 8 week of treatment with limited benefits after this 8 week time frame. Patients are encouraged to utilize Physical Therapy early in their recovery process to accelerate their recovery.

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Mental Health and Its' Impact on Shoulder Function

 "We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world."  - Buddha.

Mental health has a significant impact on recovery from many musculoskeletal diagnoses including low back pain, neck pain, and shoulder pain.  Our thoughts and perceptions about our bodies and their ability to recover from injury and illness strongly influence our course for recovery and healing.  In prior posts we have described the limitations of imaging such as MRI and CT for musculoskeletal diagnoses.  In particular, we can find the same pathology (disc herniation or rotator cuff tears) in people with and without symptoms.  Thus, imaging does not correlate strongly with how patients function and what symptoms they experience due to these imaging findings.  

A recent study in the Journal of Bone and Joint Surgery highlights both the limitations of imaging findings and the importance of mental health on patient function (Wylie et al. 2016).  The authors recruited close to 200 patients with complete rotator cuff tears to determine which clinical and diagnostic factors correlated best with the patients' symptoms of shoulder pain and function.  Interestingly, a patient's mental health had the strongest association with the patient's reporting of pain and shoulder function.  This association was stronger than the correlation between the severity of the shoulder injury on MRI and their reporting of pain and function.  

This study adds evidence to support the assessment of mental health variables in individuals suffering from musculoskeletal pain and may help us understand which patients can or cannot function well given a positive imaging finding.  In our experience, patients with a positive outlook on their recovery have the most optimal outcomes with Physical Therapy.

Physical Therapy or Surgery for Rotator Cuff Tears

Despite having no symptoms, many of us will develop age related changes in the musculoskeletal structures of our bodies, similar to the aging effects on our skin. These findings are most prevalent on highly sensitive imaging techniques such as MRI and often lead to unnecessary and costly medical procedures. Our shoulders are also prone to development of age related changes including rotor cuff muscle tears which may or may not be symptomatic or interfere with our functional and recreational activities. In particular, rotator cuff tears are age dependent and the prevalence of both symptomatic and asymptomatic tears increases with increased age (Sher et al. 1995). For example, 1 in 3 adults over the age of 60 will have a rotator cuff tear on MRI (Fehringer et al. 2008). A Key question to ask when these changes are found would be, "what treatment, Physical Therapy or surgery, is most effective for my symptoms?"

A recent article asked the question, "Which is the most effective treatment for non traumatic rotator cuff tears?" Kukkonen and colleagues released their findings in this month's Journal of Bone and Joint Surgery (2015). They studied 167 shoulders (full thickness supraspinatus tears) in 160 patients and randomized these patients to one of three groups. 1. Physical Therapy 2. Physical Therapy plus bone spur removal and 3. Physical Therapy, bone spur removal and rotator cuff repair. All of the patients who entered the study had functional range of motion in their shoulders before being randomized. Patients were followed for up to 2 years which provided excellent data on symptoms, function, and patient satisfaction. The authors found no significant differences between groups on patient satisfaction, symptoms, and function at the 2 year follow up.    

rotator cuff tear physical therapy versus surgery
boulder physical therapy shoulder surgery versus physical therapy

Given the long term evidence, individuals with non-traumatic tears should strongly consider a 8-12 week course of Physical Therapy prior to any surgical intervention. Failure of conservative treatments including Physical Therapy, unrelenting night pain, and progressive loss of function warrants surgical consultation. To learn more about the effectiveness of conservative treatments for rotator cuff disease contact your local Physical Therapy experts at Mend.