Summary

The potential for improvement for non-operative treatment of full-thickness Supraspinatus tears may be limited, yet exists irrespective of patient age, affected side, symptom duration and severity, prior pain medication, or previous conservative treatment.

Abstract

Aim

The aim of the present study was to study the effect of conservative treatment in the presence of a full-thickness Supraspinatus tendon tear and to analyze potential prognostic factors for treatment success.

Background

Full-thickness tears of the rotator cuff are generally accepted as an indication for surgery. While promising results have also been reported for conservative treatment, there is a lack of evidence concerning prognostic factors and efficacy.

Methods

Fifty-six shoulder joints, 38 right- and 18 left-sided, in 56 patients, 33 women and 23 men, mean age 63.2 ± 10.7 (range, 41 to 84) years, without prior trauma, with a full-thickness supraspinatus tendon tear on MRI, who opted for non-operative treatment were included into the present study. Patients were revaluated after a mean 66 (range, 18 to 140 days). Western Ontario Rotator Cuff (WORC) Indices were obtained at baseline and follow-up. The influence of age, gender, affected side, mean duration of symptoms, prior pain medication, prior conservative treatment, and patient expectation of the effectiveness of conservative treatment were analyzed.

Results

Mean WORC indices statistically significantly improved from 135.7 ± 5.2 to 123.2 ± 6.1 (p=0.02). WORC indices at follow-up correlated with initial WORC indices (r=0.585, p<0.001). No differences were observed between men and women. Right-sided shoulder joints had higher WORC indices at baseline and follow-up (p=0.03 and 0.04, respectively) but improvement did not differ between sides. No correlation was observed between WORC indices and age, symptom duration, or duration of follow-up. Patients taking pain medication at baseline had significantly higher WORC indices at baseline and follow-up (p=0.025 and 0.024, respectively) but had similar improvement compared to patients without pain medication. No difference was observed between patients who underwent conservative treatment before their initial presentation compared to patients without prior treatment. Patients who thought they would need surgery at baseline had higher WORC indices at baseline and follow-up (p=0.045 and 0.044, respectively) but similar improvement to patients who thought they would not need surgery.

Conclusion

The results of the present study suggest that potential for improvement may be limited, yet exist irrespective of patient age, affected side, symptom duration and severity, prior pain medication, or previous conservative treatment. Patient expectations and symptom severity correlate, yet the extent of improvement does not. Nonoperative treatment is effective in patients with full-thickness Supraspinatus tendon tears.