Conservative management of rotator cuff tears: literature review and proposal for a prognostic. Prediction Score

Abstract

Rotator cuff tears are a common cause of pain and shoulder dysfunction. The prevalence of the rotator cuff tears increases with the age reaching the 80% in patients aged more than 80 year. Symptomatic shoulders usually are initially treated conservatively and then, in case of poor outcomes, with surgery. Different parameters are still used to decide between the conservative or surgical treatment in patients with rotator cuff tears. Aim of the current study is to characterize the various features used in decision making and to validate a "Prediction Score" that let us know which patients could have a good and stable outcome with non operative treatment. We enrolled 60 patients (mean age 52 years) with symptomatic rotator cuff tears who were assigned to conservative treatment and were evaluated at 6,9 and 12 months follow-up. We developed a score based on 18 clinical and radiographic parameters. 27 patients ("non conservative") (45%) with a mean prediction score of 16.1 ± 1.7 interrupted the conservative treatment, while 33 patients ("conservative") (55%) with an average prediction score of 11.3 ± 1.8 remained conservatively treated at last follow-up. The conservative patients were 14 years older than non conservative patients. According to the results of this study we identified a value of 13 points as a "cut-off" score to predict good results by conservative management of rotator cuff tear. These outcomes support the assumption that a predictive prognostic score may guarantee a rational approach in the management of subjects with RC tears, especially in elderly who continue to have the higher rate of recurrence and therefore could be well treated with standard conservative therapies.

Keywords: conservative treatment; prediction score; rotator cuff; shoulder.

Figures

Figure 1

A–B Clinical assessment of “drop sign”. When the examiner place the shoulder at 45° of external rotation (A) and it drop back to 0° (B) the test is positive.

Figure 2

Patient’s position to evaluate scapular dyskinesis.

Figure 3

Constant-Murley score of the study population at all three follow-ups.

Figure 4

Course of pain score in the “conservative” and “non conservative” subjects from baseline to 12 months