Conservative Treatment of Rotator Cuff Tears: Where are the Limits?
Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan Eiji Itoi, M.D.
Lecture 1(20~25 min lecture) Special Lecture
Rotator cuff tear is the most common disease of the shoulder observed in the elderly population. Patients who visit us have symptoms such as pain or muscle weakness. However, we know nowadays that most people with rotator cuff tears are in fact without symptoms. Just a handful of people have symptoms and visit us. We need to keep this in mind when we look at patients with rotator cuff tears and consider treatment options. Pain is sometimes associated with tear extension. Tear extension is related to biomechanical environment of the cuff tendons such as stress concentration as well as the changes of the tendon itself such as tendon degeneration. Several studies have been reported regarding the conservative treatment.
However, the success rate varies greatly among them. The outcome of conservative treatment should include those who underwent surgical treatment as failure cases. By doing this, the more surgery you do, the less satisfactory the outcome of conservative treatment is. In our series in which only 2.9% were surgically treated, the satisfactory results were obtained in 75% of the patients. The range of motion in external rotation is a significant predictor of successful conservative treatment. This is related to the muscle function of the external rotators. In conclusion, we can reduce the pain using the conservative treatment in most of patients with rotator cuff tears. We can expect a satisfactory outcome when the external rotator function is well preserved.
Inviting Lecture
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