Effectiveness of PT in treating full-thickness rotator cuff tears
Rotator cuff tears occur frequently in the United States; approximately 10% of the population over age 60 will experience one at some point. This roughly totals 5.7 million people per year with tears. Surgery is performed on about 5% of these people. Although many think surgery is the be all end all of orthopedic injuries, evidence suggests that surgeries to repair large rotator cuff tears fail 25-90% of the time. Interestingly, even if a patient’s surgical repair fails, quite frequently his or her satisfaction level and outcome scores often remain as high as those whose repairs are intact. A study published in 2013 in the Journal of Shoulder and Elbow Surgery hypothesized that post-operative physical therapy may be responsible for the improvements seen in shoulder function, despite the outcome of the surgery.
Participants in this study were divided into two groups. The first group was provided a home-based physical therapy plan with a DVD that demonstrated the exercises. The second group attended in-person physical therapy sessions, where they were treated with a variety of interventions to improve mobility, flexibility, and strength. These patients attended therapy sessions three times per week and were progressed to a home program when they were ready.
After six weeks of one intervention or the other, the patients were given three options that are listed below:
- They considered themselves cured and could stop treatment.
- They were “improved” and could continue with six additional weeks of therapy.
- They were “no better” and could elect to have surgery. Participants could also choose to have surgery to repair their shoulder at any point following the six-week mark.
Over the first 6 weeks, patients averaged only 8 supervised physical therapy visits. Of the 422 participants, only 35 of them, or 8%, chose to have surgery during this time period. After an additional six weeks of therapy, an additional 24 patients elected to have surgery. In other words, after 12 weeks of therapy, 87% of the participants in this study were feeling good enough to avoid surgery altogether! These patients were followed for an additional 2 years, and even without more therapy, 74% of the group was doing great and did not need surgery.
The main takeaway from this study is that physical therapy alone is very effective in the treatment of full-thickness rotator cuff repairs, to the extent that surgery may not be necessary. Of course, you should consider the cause of your tear, other health conditions, the size of your tear, and the activities you would like to keep doing before deciding if surgery is appropriate or not. If you are on the fence about having surgery to repair a rotator cuff tear, we would encourage you to seek physical therapy first. With the help of manual techniques, strengthening, and other treatments, your physical therapist may be able to save you time, money, and help you avoid surgery altogether.
Source: Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., Brophy, R. H., Carey, J. L., Holloway, B. G., Jones, G. L., Ma, C. B., Marx, R. G., McCarty, E. C., Poddar, S. K., Smith, M. V., Spencer, E. E., Vidal, A. F., Wolf, B. R., Wright, R. W., & MOON Shoulder Group (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of shoulder and elbow surgery, 22(10), 1371–1379. https://doi.org/10.1016/j.jse.2013.01.026