The 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.
After 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.