Will the effects of non-surgical treatments be more beneficial than surgical treatments for rotator cuff injuries to increase range of motion in upper extremities to complete activities of daily living and instrumental activities of daily living? To determine the answer to this question, rotator cuffs and their injuries will need to be defined. A rotator cuff is a group of four muscles on a person’s shoulder blade that attach to the ball of the humerus. The muscles and tendons allow a person to lift and rotate their arm, and hold the ball of the humerus firmly in place within the shoulder socket.
Injuries can occur to the tendons of the rotator cuff by falls, blunt trauma to the shoulder, repeated actions, and age. The injury is characterized by the tearing of a tendon, and can cause limited range of motion and pain in the shoulder. Swelling, crepidus and stiffness are all common symptoms associated with the injury, and symptoms will be more severe if a complete tear has happened, because the tendons will have been torn away from the bone. When the rotator cuff has been damaged there are two options for treatment which are either non-surgical or surgical.
Non-surgical methods are non-invasive treatments that include physical and occupational therapy, taking oral medications like acetaminophen, taking steroids by pill or injection to alleviate pain, and using modalities like ultrasound, heat, ice, and electrical stimulation (S. Oh, et al 2006). Occupational and physical therapist can use eccentric strengthening programs to target the patient’s functional limitations due to a rotator cuff injury. The therapy helps to promote scapular control and correct movement patterns. The exercises have been proven to help decrease pain and increase function in patients with stage three subacromial impingement syndrome (Bernhardsson, Hultenheim-Klintberg & Kjellby-Wendt, 2010).
The syndrome includes partial or complete rotator cuff tears, supraspinatus and infraspinatus damage, bursitis, tendon disease, weakness of the rotator cuff muscles, and irregular shaped acromion were found to be beneficial treatments for patients preoperatively (Bernhardsson, Hultenheim-Klintberg & Kjellby-Wendt, 2010). Patients that do not meet certain surgical criteria can be associated to their age, work demands, or because of successful non-operative treatments (S.Oh, et al 2006).
In order for non-surgical treatments to be effective, the patient will need to follow the instructions and regiments the doctors, physical therapists, and occupational therapists prescribe. Surgery is the second option available for a person with a rotator cuff injury. During a rotator cuff repair the doctor will either have to stitch the torn edges of the muscle of tendon back together again, or reconnect the tendon back to the ball of the humerus. Other types of repairs that the doctor may decide to do could be debridement or acromioplasty.
Debridement removes loose fragments of the tendon, damaged bone, or cartilage that may be lodged in the joint, and acromioplasty will either remove bone from underneath the shoulder blade, or remove some of the ligaments in the shoulder joint to allow more room to move the arm. The repair method used will depend on the circumstances and extent of the patient’s injury. Three types of surgery are used for a rotator cuff injury.
Arthroscopic surgery has been shown to have the least amount of recovery time, and involves making a small opening into the muscle of the shoulder to allow for insertion of an athroscope (a small tube attached to a camera and surgical instruments) to repair the tear. Open surgery is required to create a large opening in the muscle of the shoulder in order to repair the tear with standard surgical instruments. Lastly is mini-open surgery; an arthroscope is used during the first part of the surgery, and then an opening is made to allow access for regular surgical instruments to repair the rest of the tear (S. Oh, et al, 2006).
Studies have shown that there are some factors that will determine if non-surgical therapy will be more beneficial than surgery. Some determinants used to predict the type of intervention include the size of the tear in the rotator cuff, preoperative strength in the arm and shoulder, range of motion, age of the patient, and worker’s compensation (S. Oh, et al). Some data shows that patients with preoperative active abduction, that was less than 100 degrees, had 9 times greater risk of having an unsatisfactory outcome with surgery when compared to patients that had a preoperational active abduction range greater than 100 degrees.
Range of motion can also be used to determine the severity of the tear in the rotator cuff. The data suggests that smaller tears respond better to an exercise regiment when compared to massive tears. Massive tears were found to have less recovery when exercised and a higher rate of re-rupture after surgery. Massive tears were more common in patients 65 years and older due to the quality of their rotator cuff tendons being poor, having greater degrees of retraction, and fatty displacement build-up.
Preoperative strength of abduction and external rotation is a prognostic factor that is used to determine the success of a surgery performed on the patient. Evidence shows that the more strength the patient has before surgery the chances of a beneficial recovery increases, and patients who demonstrated flaccid muscle tone in their problematic extremity were less likely to receive successful recovery with surgery (S. Oh, et al, 2006). After examining the data there is no definitive proof that one method of treatment is better than the other to increase range of motion in the upper extremities for people to perform activities of daily living and instrumental activities of daily living.
There were too many variables to consider. The treatment plan will be influenced by the extent of the injury, the age of the patient, and other medical conditions present that could contribute to other complications. Insurance imbursement and monetary aspects also have to be considered and can play a tremendous role in the healthcare that a patient receives. Physicians will need to determine which technique, surgery or alternative therapy, will be most beneficial for each patient individually.
Refernces S. Oh, MD, MS, L. , Wolf, MD, MS, B. R., Hall, MD, M. P. , Levy, MD, B. A. , & Marx, MD, MSc, FRCSC, R. G. (2006). Indications of rotator cuff repair. Retrieved from moonshoulder. com Bernhardsson, S. , Hultenheim-Klintberg, I. , & Kjellby-Wendt, G. (2011). Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome. ProQest Social Science Journals, (25. 1), 69-78. Retrieved from http://search. proquest. com. jsrvproxy1. sunyjcc. edu/socscijournals/docview/82123 5530/141CDBE57BC67A52926/1? accountid=39896.