rotator cuff physical therapy

Can Physical Therapy Help You Avoid Rotator Cuff Repair Surgery?

physical therapy rotator cuff tearThe shoulder joint requires tremendous amounts of mobility to function, making it inherently unstable and prone to injuries.  Overtime, this amount of mobility can lead to injuries of the shoulder, including rotator cuff tears.

Unfortunately, rotator cuff tears are common.  Rotator cuff surgeries are performed on between 75,000 to 250,000 patients per year in the U.S despite several studies showing high failure rates.  While there are many factors associated with these failure rates, rehabilitation has been advocated as a first line of defense by many to avoid surgery.

 

Physical Therapy for Rotator Cuff Tears

A recent study published in the Journal of Shoulder and Elbow Surgery looked at the effectiveness of physical therapy in treating rotator cuff tears.  The study was performed by the MOON Shoulder Group, a group of prestigious orthopedic surgeons and research personnel from around the U.S.  The manuscript won the 2012 Neer Award for Clinical Research, too!

The study followed over 400 patients with rotator cuff tears that were undergoing physical therapy to see if rehabilitation along could help people reduce pain and return to function.

rotator cuff physical therapyAfter 6 weeks of physical therapy, only 9% had elected to undergo rotator cuff repair surgery., at 12 weeks only 15% elected to have surgery, and in total over the course of the study only 26% of people  elected to undergo surgery based off of their symptoms and function.

The way I see this, 74% of patients with rotator cuff tears were able to avoid surgery and return to function without significant limitations.  Interestingly enough, if a patient elected to undergo surgery, they usually did so within the first 12 weeks.  If patients did not have surgery after 12 weeks of physical therapy then the patient was most likely to avoid surgery at a later point.   The study followed patients for 2 years, which meant most patients were able to carry on with their lives normally and did not need surgery down the road.

 

74% of patients with rotator cuff tears were able to avoid surgery by performing physical therapy

 

Another recent study in the Journal of Shoulder and Elbow Surgery, also looked at physical therapy for rotator cuff tears in patients that did not have sugrery.  In this study, patients were followed for 13 years (that’s right, 13 years!!)  and found that 90% of the patients had no or only slight pain in their shoulder.

That’s a long term outcome that I can handle and imagine the cost savings. And speaking of cost savings, it has been reported that surgery often exceeds the costs of nonoperative treatment.  The cost for surgery was ~ $15,000  while nonoperative treatment was only ~$1800.

Just eye opening! What a difference physical therapy can make in avoiding surgery and saving the patient pain, time and money…never mind the stress on his family and the health insurance industry.

A properly designed physical therapy program, which includes emphasis on improving motion, enhancing muscle imbalances, and restoring dynamic stabilization of the shoulder joint, can help many people avoid rotator cuff repair surgery.

 

 

20 replies
  1. Kjetil
    Kjetil says:

    This may be viable information for the general population, but I think it’s important to mention that a rotator cuff tear for a lifter is a huge problem.

    Reply
    • Mike Reinold
      Mike Reinold says:

      Hi Kjetil, I would agree a cuff tear is a problem in a lifter, though the same principles would apply. Key here is early detection to you don’t work through too much and cause the tear to get worse. This also underscores the importance of proper arm care with your programming.

      Reply
  2. Teresa Merrick
    Teresa Merrick says:

    I’m left to wonder what “carry on their lives normally” actually meant in the group that ultimately did not get surgery. Did they, in fact, resume activities that had previously been problematic? Or did they end up limiting themselves in activities in a somewhat downward spiral? Must be careful to interpret the results.

    Reply
    • Max Selisch
      Max Selisch says:

      Good question…I would imagine most of these folks did not normally or usually perform much overhead or out-from-body activities that required greater stabilization of the GH joint.

      Reply
    • Lenny Macrina
      Lenny Macrina says:

      Agreed there is some interpretation but it is encouraging that they were able to avoid surgery and maintain a “normal” lifestyle for them. If they had significant limitation in their ADL’s, I would imagine they would’ve elected for surgery.

      Reply
  3. Charla
    Charla says:

    Do you think it depends on the extend if the tear ie: a partial thickness tear compared to a full thickness tear?

    Reply
    • Mike Reinold
      Mike Reinold says:

      Charla, it sure does. The more progressive of a tear, the worse the outcomes. Early detection and getting on the right program to prevent a partial from becoming a full thickness is key!

      Reply
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  4. Nick Rainey
    Nick Rainey says:

    I wonder if the $15,000 takes into account the care by a PT after surgery. I always find it funny that some people have surgery, see a PT for a few months, then attribute their improvement to the surgery. I wonder how often same amount of time of seeing a PT would have helped without the surgery. In RC repairs it seems that 3 out of 4 patients this would be the case!

    Reply
  5. Shane Carpenter
    Shane Carpenter says:

    Torn RTC, torn biceps, torn labrum. R shoulder. I’m R handed. I’m a surfer and a physical therapist. No surgery, and I’m doing pretty well. Sure it cracks and clunks from time to time.. but it probably would anyway after surgery.

    Reply
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Trackbacks & Pingbacks

  1. […] not be required and that PT is a logical and cost saving way to return function. I wrote about how physical therapy can help avoid rotator cuff repair surgery a while back in a blog post and continue to believe that PT is way under […]

  2. […] and Performance in Boston are rotator cuff tears.  Luckily, we’ve discussed in the past that 74% of people with rotator cuff tears are able to avoid surgery by performing physical therapy.  Despite the optimistic outcomes, people with rotator cuff injuries often have pain with […]

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