Results from a new study presented at the annual meeting for American Shoulder and Elbow Surgeons, have revealed physical therapy may reduce the need for surgery for rotator cuff tears. After following participants for five years, the researchers discovered patient expectation was the main predictor of surgery.
Surgery for rotator cuff tears is renowned for its long and often painful recovery process. So, could these latest results change how rotator cuff tears are treated? Here, we’ll look at the study and its findings, and whether physical therapy could prove more effective than surgery.
The findings of the study
The study led by John. E. Kuhn followed a total of 433 patients for five years, who had been diagnosed with an atraumatic full-thickness rotator cuff tear. Data was provided via questionnaires on factors such as willingness to undergo surgery, symptom characteristics, comorbidities, patient-related outcome and demographics.
The researchers also created a physical therapy routine that the participants followed, and they were assessed at 6 and 12 weeks. During the final evaluation, the patients were asked to choose between three different options. These included, cured with no follow up required, improved followed by continued therapy and an assessment in 6 weeks, and no better with the option of surgery.
Out of all of the participants, just 24% had opted to have rotator cuff surgery, with 75% choosing not to undergo surgery. Those who did undergo surgery, largely did so within the initial 12 weeks of therapy. Activity scale, smoking and patient expectations were the three driving factors behind the 2-year results. After five years, the size of the tear and workers compensation both had a major influence on surgery decisions.
The most significant finding was that patients who believed the physical therapy would work, did find it to be effective. So, patient expectations certainly play a role in the effectiveness of physical therapy.
Should surgery be used as a last resort for rotator cuff tears?
These new findings certainly aren’t surprising. Shoulder specialists have been using physical therapy as a first response treatment for years now. Due to how complex rotator cuff surgery can be and the long recovery time, it is typically used as a last resort treatment. However, what the research could aid with, is convincing patients that physical therapy can work. As there is a direct link between patient expectations and therapy outcomes, ensuring they understand the benefits of physical therapy is crucial.
It is also important to recognise when surgery would be most effective. This can typically be determined fairly early on if the pain isn’t subsiding. However, numerous factors will be assessed before deciding whether or not surgery is the best course of treatment moving forward.
This new research highlights the importance and effectiveness of physical therapy as a first treatment option for rotator cuff injuries. It also provides hope for patients, showing surgery may not necessarily be required. Those who do suspect they are suffering from a rotator cuff injury should seek treatment as soon as possible. The earlier it is diagnosed, the more effective physical therapy is likely to be.