PAIN+ CPN

Doctor, I have a rotator cuff tear, is having surgery to repair it better than conservative treatment?

This review showed that people who had surgery and people who had conservative treatment both experienced improvement in pain and function of their shoulder over time. You should speak with your doctor about which choice is best for you.

What is the evidence?

SUMMARY OF FINDINGS:

Surgical repair vs conservative treatment for rotator cuff tear

OutcomeNumber of StudiesEffectCertainty of Evidence
Pain at 24 months2 (207 participants)People who had surgery had an average reduction of 0.93 points* more on a pain scale (ranging from 1 to 10) compared to people who had conservative treatmentModerate**
Function at 24 months2 (207 participants)People who had surgery had an average increase in function of 5.5 points* more on a function score (ranging from 1 to 100) compared to people who had conservative treatmentModerate**

*most people would not notice a difference of this amount

**the true effect is likely to be close to the estimated effect, but there is a possibility that it might be substantially different


What kind of study was this?

This was a systematic review.

Who? This review included 6 randomized controlled trials involving 435 people (average age 56 to 65 years) who had a rotator cuff tear (average size 8.5 to 15.6 mm) causing pain and limitation of function (average of 10 to 28 months). People with shoulder fractures or dislocations or frozen shoulder or previous shoulder surgery or a disease like rheumatoid arthritis were excluded. All 6 studies were judged to have some concerns about the quality of the study with 2 studies having serious concerns.

What? The reviewers included studies that compared any type of surgical repair with any type of conservative treatment.

Surgery

vs

Conservative Treatment

Surgical repair ranging from arthroscopic (small, pencil-like incision with a short recovery time) to open (large incision with longer recovery time)



Conservative treatment: physiotherapy, home exercises, injections of steroids, anti-inflammatory medications taken by mouth



Why was this research done?

Shoulder problems are a common reason for people to attend pain clinics. For rotator cuff tears that are not large, it can be difficult to know if surgery should be recommended over conservative treatments like physiotherapy and steroid injections. Surgery directly fixes the tear but exposes the person to the risks of anesthesia and infection and recurrent tears are common. Conservative treatments may reduce pain, but loss of strength, and worsening of the tear size over time are concerns. The reviewers in this paper wanted to know if the evidence supported offering surgery to everyone with a rotator cuff tear, regardless of size or how the tear occurred (due to injury or not). They found that people who had surgery and people who were treated with conservative treatment both improved over time with no clear evidence that one treatment was better than the other. However, the quality of the evidence was low to moderate which means that conservative treatments are a good option, but there may still be some people who would benefit more from surgery.

This Evidence Summary is based on the following article:

Brindisino F, Salomon M, Giagio S, et al. Rotator cuff repair versus nonoperative treatment: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2021 May 18. pii: S1058-2746(21)00431-6. doi: 10.1016/j.jse.2021.04.040. PubMed

Published: Friday, October 8, 2021