Lack of Belief about PT predicts RC Surgery

You have a 60 year old patient in front of you who gloomily shows you his MRI report confirming that he has an atraumatic full thickness supraspinatus tear and partial thickness infraspinatus tear. He is debating if he should get surgery or not? What is your suggestion?

There are some people with rotator cuff (RC) tears who functionally recover 100% with conservative care and there are others who simply do not respond to any PT strengthening exercises and eventually improve after a RC surgical repair. The purpose of this study was to identify patients with full thickness RC tears who fail to respond to non-operative treatments and opt for surgery.

Of the 433 subjects followed for 2 years, 87 (20%) underwent surgery and 80% did not.

The following factors were predictive of surgery…

*Low expectations regarding the potential benefits of physical therapy

*Low activity level

*Smoking history

The following factors were NOT predictive of surgery…
*Location of the RC tear

*Severity of the RC tear

*Severity of pain

Clinical Relevance: If the patient questions the value of PT or believes PT is useless since he/she has a full tear, then they are very likely to receive RC surgery. On the other hand, if the patient believes that the RC tear is part of a normal aging process and that PT can be very effective, remains active and does not smoke, then he/she is unlikely to undergo surgery…simply fascinating!

Reference: Dunn WR et al 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016 Aug;25(8):1303-11.