Authors:

John E. Kuhn, MD, MS, Warren R. Dunn, MD, MPH, Rosemary Sanders, BA, Qi An, MS, Keith M. Baumgarten, MD, Julie Y. Bishop, MD, Robert H. Brophy, MD, James L. Carey, MD, MPH, Brian G. Holloway, MD, Grant L. Jones, MD, C. Benjamin Ma, MD, Robert G. Marx, MD, MS, Eric C. McCarty, MD, Sourav K. Poddar, MD, Matthew V. Smith, MD, Edwin E. Spencer, MD, Armando F. Vidal, MD, Brian R. Wolf, MD, MS, and Rick W. Wright, MD MOON Shoulder Group

Abstract:

Purpose

To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design.

Materials and methods

Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores.

Results

The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.

Conclusion

Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.