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March 02, 2011

Award Winning Research

Award-winning research from Vanderbilt University was presented at the recent AAOS 2011 annual meeting in San Diego showing that exercise alone is very effective for people with rotator cuff tears.  This large study was on 396 patients, ages 18 to 100 years, who had full thickness tears in their rotator cuffs documented by MRI.  The primary symptom in most of these patients was shoulder pain.  These patients were put in a physical therapy program that included daily exercises, stretching, and active range of motion, all performed three times weekly.  The outpatients were initially shown how to do the exercises with the therapist and then were released to home therapy.  The patients were questioned via telephone at one to two years to determine if they had subsequently undergone surgery. 

The study showed a statistically significant improvement at six to twelve weeks using standardized measurements.  It showed that this initial improvement actually held up over the subsequent two years, and very few of these people, only 2%, had opted for surgery.  Dr. Kuhn, who headed the study, noted that the significant strength was its large size with many patients, with the inclusion of patients from multiple practices nationwide.  It was noted that the physical therapy program alleviated the pain and improved function without any specific therapy for the tear.  It basically showed that the tear could be overcome and that these people did well even though they had a full thickness tear in the rotator cuff.  Again they did well with physical therapy initially, followed by a home exercise regimen. 

This is very hopeful.  I believe that this research helps us plan a road map for patients that full thickness rotator cuff tears do not automatically mean surgery.  A significant message that health care providers need to put forth is that even though there is a rotator cuff tear, that is doea not equal surgery, and I think that our patients will benefit from this education.  I look forward to and anticipate more research that will help us confirm a future road map and more standardized treatment.  I think that at this moment in time, many patients don’t understand this.  They hear the word “tear” and they in their minds think it absolutely requires repair when in fact that is not the case.  We should always remember that the goal is to restore function and relieve pain.  We do not always need to make people anatomically perfect to do this.  It is also noteworthy that there is other research saying that 60% of 60-year-olds have a tear in their rotator cuff.  Obviously many of them are doing remarkably well.  The other thing to remember is that there are recent studies to suggest that shoulder function is forever altered after surgery is done.  This research came out of the Henry Ford Hospital system in Detroit.

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