Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

BackgroundRotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a f...

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Published in:Annals of the rheumatic diseases Vol. 80; no. 6; pp. 796 - 802
Main Authors: Cederqvist, Sanna, Flinkkilä, Tapio, Sormaala, Markus, Ylinen, Jari, Kautiainen, Hannu, Irmola, Tero, Lehtokangas, Heidi, Liukkonen, Juho, Pamilo, Konsta, Ridanpää, Tero, Sirniö, Kai, Leppilahti, Juhana, Kiviranta, Ilkka, Paloneva, Juha
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2021
Elsevier Limited
BMJ Publishing Group
Subjects:
Adult
Arthritis
Arthroscopy - methods
Decompression
Follow-Up Studies
Hospitals
Humans
Informed consent
Injuries
Magnetic resonance imaging
orthopedic procedures
Pain
patient reported outcome measures
Patients
Rehabilitation
Rotator cuff
Rotator Cuff - diagnostic imaging
Rotator Cuff - surgery
Shoulder
Shoulder Pain - etiology
Surgery
tendinopathy
Tendons
Treatment
Treatment Outcome
Finland
orthopedic procedures
patient reported outcome measures
rehabilitation
tendinopathy
ISSN:0003-4967, 1468-2060, 1468-2060
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Summary:BackgroundRotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear.MethodsIn a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up.ResultsAt the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery.ConclusionsNon-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment.Trial registration detailsClinicalTrials.gov, NCT00695981 and NCT00637013.
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ISSN:0003-4967
1468-2060
1468-2060
DOI:10.1136/annrheumdis-2020-219099