Applied Evidence

Conservative care or surgery for rotator cuff tears?

J Fam Pract. 2020 March;69(2):66-72
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Significant injury to the deltoid muscle has become increasingly uncommon with the advancement of arthroscopic surgery. In traditional open surgery, detachment of the deltoid (and subsequent repair) is required to improve visualization; however, doing so can lead to atrophy and muscle rupture and dehiscence. Deltoid damage occurs in ≤ 60% of open surgeries but is negligible in arthroscopic and mini-open repairs, which involve splitting deltoid fibers to gain exposure of the underlying rotator cuff.54

SIDEBAR
Key takeaways in the management of rotator cuff injury

  • Chronic, nontraumatic, and partial-thickness tears respond well to conservative management as first-line treatment. Poor surgical candidates should also be offered a trial of conservative therapy.
  • Consider referral for surgical consultation if the patient does not respond to conservative therapy in 6 to 12 weeks; also, patients who have a full-thickness tear and young patients with traumatic injury should be referred for surgical consultation.
  • Arthroscopy has become the preferred approach to rotator cuff repair because it is associated with less pain, fewer complications, and faster recovery.
  • Patients should be counseled that recovery from surgical repair of a torn rotator cuff takes, on average, 6 months. Some massive or retracted rotator cuff injuries require more extensive procedures that increase healing time.
  • Overall, patients are “happy” with rotator cuff repair at 6 months; clinical complications are uncommon, making surgery a suitable option in appropriately selected patients.

CORRESPONDENCE
Cayce Onks, DO, MS, ATC, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Family and Community Medicine H154, 500 University Drive, PO Box 850, Hershey, PA 17033-0850; conks@pennstathealth.psu.edu.

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