Did you realise that only 5–11% of people aged between 40–60 but up to 80% aged 70 years or older have rotator cuff tears? Which raises the question, is there an alternative to surgery for shoulder pain?
Shoulder Pain & Surgery
It can be a story we all hear as practitioners commonly in the clinic. You’ve had a long history of ‘niggly’ but debilitating shoulder pain which has been limiting you from lifting your arm overhead, interrupting your sleep, impacting simple household and menial tasks or maybe even progressed to have stopped you from going to work or forced you from your weekend surf. So, you’ve gone to your GP who has given you some medication, which has helped a little, but still it’s not the way it used to be.
Multiple visits to the local radiology department and a few scans later, your doctor arrives at the conclusion that you have a tear present in the rotator cuff of your shoulder. Immediately, an increase of fear and anxiety floods your mind. You start thinking of all the stories of your friends or friends of friends that have had a similar case who went on to have surgery and/or longstanding pain. That’s not an avenue you want to go down but furthermore you’re not sure if there’s any other option.
The Rotator Cuff Role & Function
As mentioned earlier this is quite a common picture that we see as clinicians here at ATUNE Health Centres as rotator cuff tears are present in approximately 5%–11% in subjects aged 40–60 but 80% in those aged 70 years or older. This reveals the great symptomatic and economic burden of this condition. However before delving deeper into management of rotator cuff tears, it is important to understand the role and function of the rotator cuff.
Simply, the rotator cuff (RC) are a group of four muscles deep in the shoulder that help to keep the top of the humerus (arm bone) centered within the concave “socket” provided by the shoulder blade, or scapula. What this can be like functionally is similar to that of a golf ball sitting on a golf tee. The RC also helps prevent excessive movement of the humerus (golf ball) in which stabilises it within the concave shoulder joint (golf tee) even during all movements, such as when you move your arm overhead or when throwing a ball.
Alternatives to Surgery
With all this in mind though, there is still the great weight placed upon the decision of how to manage the condition and the questions raised - is there any option other than a surgical treatment? Hopefully, this is where we can settle some of those anxious thoughts.
In some really helpful research performed in the last few years, results showed that even in the presence of rotator cuff tears, exercise therapy and conservative management (the absence of surgery) were extremely beneficial and even helped to avoid surgery. In a study performed in 2014, 180 patients with partial tears of their rotator cuff were divided into random groups in which some were given physiotherapy as sole treatment, including exercise therapy, and the others given surgery and physiotherapy. The results showed there were no significant difference between the two groups!
Now, I know what you’re thinking, this was only because these patients had “partial tears” present in the muscles in their shoulder. However, another study showed that exercise therapy significantly reduced the need for surgery by 75% in patients with a full rotator cuff tears even 2 years after the initial onset of pain! Along, with the symptomatic benefit and effectiveness of conservative exercise therapy there is also a great economic benefit in reducing the cost of treatment significantly.
Despite the frustration, and often anxiety, presented when faced with a diagnosis that seems quite distressing we can see that often a conservative management approach can be an effective option to turn to. In this context, we can see there is great evidence that exercise therapy has an influential and effective role in shoulder pain and in particular rotator cuff pain or injury.
At ATUNE Health Centres, our manual therapy team, including Physiotherapists, Osteopaths, are well equipped in implementing these principles and trained to deliver the best patient centered, integrative care.