Abstract
Background
Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in
adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear.
Recent studies have shown that subacromial decompression and non-surgical treatments
provide equivalent results in RCD without a full-thickness tendon lesion. However, the
importance of surgery for full-thickness tendon tears remains unclear.
Methods
In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain
underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis
of RCD. Of these, 190 shoulders remained symptomatic and were randomised to
non-surgical or surgical treatments. The primary outcomes were the mean changes in the
Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at
the 2-year follow-up.
Results
At the 2-year follow-up, both non-surgical and surgical treatments for RCD
reduced pain and improved shoulder function. The scores differed between groups by 4
(95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function.
Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to
22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured
surgery.
Conclusions
Non-surgical and surgical treatments for RCD provided equivalent improvements in
pain and function. Therefore, we recommend non-surgical treatment as the primary
choice for patients with RCD. However, surgery yielded superior improvement in pain
and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair
may be suggested after failed non-surgical treatment.
Trial registration details
ClinicalTrials.gov, NCT00695981 and NCT00637013.
Subject
General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology
Cited by
22 articles.
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