American Academy of Orthopaedic Surgeons
Management of Rotator Cuff Injuries
This guideline holds 21 recommendations, 591 references and 2 tables.
Summary
Shoulder disease is a major cause of musculoskeletal disability in the United States, affecting approximately 8% of all American adults. Rotator cuff pathology is the leading cause of shoulder-related disability seen by orthopaedic surgeons, with surgical volume and associated costs on the rise.
Key takeaways
Both physical therapy and operative treatment result in significant improvement for small to medium full-thickness rotator cuff tears.
Physical therapy improves patient-reported outcomes, but tear size and muscle atrophy may progress over 5 to 10 years with non-operative management.
Healed rotator cuff repairs show improved patient-reported and functional outcomes compared to physical therapy.
Routine acromioplasty is not suggested for therapeutic benefit as a concomitant treatment with arthroscopic repair.
Early or delayed mobilization (up to 8 weeks) yield similar post-operative outcomes.
Recommendations
MANAGEMENT OF SMALL TO MEDIUM TEARS
Both physical therapy and operative treatment result in significant improvement in patient-reported outcomes for patients with symptomatic small to medium full-thickness rotator cuff tears.
Population: Patients with symptomatic small to medium full-thickness rotator cuff tearsWhen: Small to medium full-thickness rotator cuff tears
LONG TERM NON-OPERATIVE MANAGEMENT
Patient-reported outcomes (PROs) improve with physical therapy in symptomatic patients with full-thickness rotator cuff tears. However, the rotator cuff tear size, muscle atrophy, and fatty infiltration may progress over 5 to 10 years with non-operative management.
Population: Symptomatic patients with full-thickness rotator cuff tearsWhen: Full-thickness rotator cuff tears
OPERATIVE MANAGEMENT VS NON-OPERATIVE MANAGEMENT
Healed rotator cuff repairs show improved patient-reported and functional outcomes compared to physical therapy and unhealed rotator cuff repairs.
Population: Patients with rotator cuff tearsWhen: Rotator cuff tears
ACROMIOPLASTY & ROTATOR CUFF REPAIR
The routine use of acromioplasty as a concomitant treatment is not suggested for therapeutic benefit as compared to arthroscopic repair alone for patients with small to medium sized full-thickness rotator cuff tears.
Population: Patients with small to medium sized full-thickness rotator cuff tearsWhen: Small to medium full-thickness rotator cuff tears
DIAGNOSIS (CLINICAL EXAMINATION)
Clinical examination can be useful to diagnose or stratify patients with rotator cuff tears; however, a combination of tests will increase diagnostic accuracy compared to any single clinical examination test.
Population: Patients with suspected rotator cuff tearsWhen: Rotator cuff tears
DIAGNOSIS (IMAGING)
MRI, MRA, CT and ultrasound are useful adjuncts to a clinical exam and radiographs for identifying rotator cuff tears.
Population: Patients with suspected rotator cuff tearsWhen: Rotator cuff tears
POST-OP MOBILIZATION TIMING
Postoperative clinical and patient-reported outcomes are similar for small to medium-sized full-thickness rotator cuff tears managed with early mobilization or delayed mobilization (delayed up to 8 weeks) for patients who have undergone arthroscopic rotator cuff repair.
Population: Patients with small to medium-sized full-thickness rotator cuff tearsWhen: Post-arthroscopic rotator cuff repair
POST-OP SLING USE
Following arthroscopic rotator cuff repair, in certain patient populations, outcomes are not adversely affected with immediate weaning of sling use to allow active ROM for ADLs compared to prolonged sling use because similar post-operative healing, functional outcomes, and patient-reported outcomes are achieved.
Population: Patients following arthroscopic rotator cuff repairWhen: Post-arthroscopic rotator cuff repair
