Diagnosis and Management of Partial Thickness Rotator Cuff Tears

A Comprehensive Review

Kevin D. Plancher, MD, MPH; Jaya Shanmugam, MD; Karen Briggs, MPH; Stephanie C. Petterson, MPT, PhD

Disclosures

J Am Acad Orthop Surg. 2021;29(24):1031-1043. 

In This Article

Nonsurgical Treatment

Given a low risk of tear progression, fatty infiltration, and muscle atrophy with low-grade PRCTs, nonsurgical treatment is typically the first line management, although evidence to support its use is limited.[13,14] A formal physical therapy program and the use of NSAIDs are advisable with an initial emphasis on pain control and activity modification. Internal rotation deficits and posterior capsule tightness should be addressed to facilitate restoration of shoulder active and passive ROM. Postural and periscapular strengthening exercises can improve scapulohumeral rhythm and muscle activation patterns to avoid a posture of protraction. Targeted RC strengthening should occur in a pain-free ROM and should be progressed to incorporate plyometric and functional, sport-specific or job-specific exercises to promote safe return to full activities. Subacromial corticosteroid injections can also be considered when other conservative options have failed. The 2019 American Academy of Orthopaedic Surgeons Clinical Practice Guidelines assert that there is moderate evidence (eg, low-quality evidence and benefits exceed potential harm) for improvement in pain and function in patients with shoulder pain.[25] Although short-term relief may be provided, multiple, repeated corticosteroid injections and injections administered within a year before arthroscopic RC repair carry a greater risk of complications and revision surgery.[26]

Lo et al[27] presented the results of 37 patients with PRCTs (age 52.9 ± 9.3 years, six acute, 31 chronic) treated with conservative treatment. Functional scores markedly improved at 46 ± 7-month follow-up. Seventy-six percentage did not demonstrate tear progression. Nondominant involved side, atraumatic onset, and tear thickness <50% demonstrated better outcomes. Kim et al[28] conducted a randomized controlled trial (RCT) between immediate repair and delayed repair after 6 months of nonsurgical treatment. Both immediate and delayed repair had notable improvements in pain and functional scores at 31.9 and 37 months, respectively, and similar re-tear rates. Twenty-one percent of the delayed repair group voluntarily withdrew at 6 months after nonsurgical treatment because of improved symptoms. These data support the use of nonsurgical management of PRCTs and suggest that delayed surgical intervention does not compromise outcomes at up to 3 years.

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