Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 23;20(7):5242.
doi: 10.3390/ijerph20075242.

Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review

Eoin Ó Conaire  1   2 , Ruth Delaney  3 , Alexandre Lädermann  4   5   6 , Ariane Schwank  1   7 , Filip Struyf  1
Affiliations
Review

Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review

Eoin Ó Conaire et al. Int J Environ Res Public Health. .

Abstract

Massive irreparable rotator cuff tears can cause significant shoulder pain, disability and reduction in quality of life. Treatment approaches can be operative or non-operative. Operative approaches include reverse total shoulder arthroplasty, arthroscopic debridement, partial rotator cuff repair, subacromial balloon spacers, superior capsule reconstruction, and tendon transfer procedures. Non-operative approaches include physiotherapy exercise programs and corticosteroid injections. There are no randomized controlled trials comparing the different treatment approaches. It is therefore challenging for clinicians to advise patients on what is their best treatment pathway. Physiotherapy exercise programs are less expensive and have lower risks for patients than surgical approaches. However, the success of physiotherapy in patients with massive irreparable rotator cuff tears is highly variable with published success rates of 32-96%. Several cohort studies have sought to identify if certain factors are predictive of success with physiotherapy. Several biomechanical factors were identified as possibly being related to a successful or unsuccessful outcome following physiotherapy, with complete tear of subscapularis demonstrating the strongest evidence. However, there were no appropriately designed prognostic studies. There has been a strong emphasis on biomechanical factors. Other domains such as psychosocial factors, which are important in similar patient populations, have not been explored. We recommend that further research is needed in this area and should include randomized controlled trials comparing treatment approaches and longitudinal prospective prognostic studies to identify predictors of treatment success.

Keywords: conservative treatment; irreparable; massive; non-operative; physiotherapy; prognosis; prognostic; rehabilitation; review; rotator cuff.

PubMed Disclaimer

Conflict of interest statement

A.L. is a paid consultant for Arthrex, Stryker and Medacta. He received royalties from Stryker. He is the founder of FORE, Med4Cast and BeeMed. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Patte Grade 3. formula image indicates level of supraspinatus tendon retraction.
Figure 2
Figure 2
Goutallier Grade 4 subscapularis superior, Grade 3 subscapularis inferior, Grade 2 teres minor, Grade 2 infraspinatus, Grade 1 supraspinatus.
Figure 3
Figure 3
Superiorly migrated head of humerus.
Figure 4
Figure 4
Negative tangent sign: formula image indicates supraspinatus extending above the tangent.
See this image and copyright information in PMC

References

    1. Mitchell C., Adebajo A., Hay E., Carr A. Shoulder pain: Diagnosis and management in primary care. BMJ. 2005;331:1124–1128. doi: 10.1136/bmj.331.7525.1124. - DOI - PMC - PubMed
    1. Tashjian R.Z. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin. Sports Med. 2012;31:589–604. doi: 10.1016/j.csm.2012.07.001. - DOI - PubMed
    1. Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man. Ther. 2016;23:57–68. doi: 10.1016/j.math.2016.03.009. - DOI - PubMed
    1. Denard P.J., Ladermann A., Jiwani A.Z., Burkhart S.S. Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis. Arthroscopy. 2012;28:1214–1219. doi: 10.1016/j.arthro.2012.02.026. - DOI - PubMed
    1. Thes A., Hardy P., Bak K. Decision-making in massive rotator cuff tear. Knee Surg. Sports Traumatol. Arthrosc. 2015;23:449–459. doi: 10.1007/s00167-014-3470-y. - DOI - PubMed

Publication types