Injuries and disorders of the Shoulder are best managed by an integrated team providing precise assessment and investigation, with evidence-based management comprising physiotherapy and other non-operative modalities, as well as surgical reconstruction and repair where appropriate.
Below is a list of relevant published research and papers providing support for the various treatment decisions and management options for shoulder conditions.
1. It has been estimated that less than 10% of all rotator cuff tears that are present in Americans over 60 years old are surgically repaired. That means that only a small proportion of rotator cuff tears are painful or limit activities. Being diagnosed with a tear does not mean you need surgery.
2. However, some tears are painful and need to be treated. The goal of such treatment is to restore the shoulder to normal painless function and strength. This can usually be achieved with the correct rehabilitation, but with some patients ultimately requiring a surgical intervention.
3. Research suggests that for partial and full thickness tears, a specific exercise program can reduce the need for surgery by about 65% and in fact, the published quality evidence is that the overall outcomes of surgery or physiotherapy are the same at 1, 2, 4 and 5 year follow up.
4. The treatment is generally in a staged manner to first exclude other conditions, then restore rotator cuff strength and flexibility, with those shoulders remaining symptomatic, possibly proceeding to surgery.
5. Some tears will enlarge and so repair or at least ongoing treatment and monitoring may be required to avoid long- term problems.
6. Steroid Injections can sometime help, but the benefits are generally just short term, and they may cause long- term damage, as there is good evidence that steroids can cause additional tendon tearing.
7. A plain x-ray is the most useful primary investigation for shoulder pain and will provide important information on many conditions including arthritis, instability and indicators of the chronicity of the possible cuff tear. Asymptomatic partial and full thickness rotator cuff thickness tears are very common, so finding a tear of an ultrasound is often of no relevance – and a big waste of money!
8. There are very few shoulders that need urgent surgical care – the exceptions include persistent dislocation, complete rotator cuff tear following major trauma or if associated with fractures.
9. Symptomatic shoulders that respond to the right therapy will do so within 3 months. Pain and function can settle quickly with the appropriate treatment but high-end function e.g overhead activity/repetitive manual work, can take longer.
10. Around 90% of those shoulder that do well with physio, will retain this improvement in the long term. It is important to maintain good cuff function, and so a vulnerable shoulders should undergo regular cuff strengthening exercises in the long term to avoid a recurrence of symptoms.