ShoulderTreatment options for massive rotator cuff tears
Section snippets
Assessment of key parameters in decision-making process
If it appears acceptable to define decisive parameters for treatment selection, a simple listing of these parameters is insufficient. These parameters should be quantitatively and reproducibly assessed. Unfortunately, even with quantitative clinical and imaging information, the scientific literature does not contain enough data to allow establishment of an evidence-based, universally acceptable treatment algorithm. Any proposed assessment and treatment algorithm therefore includes personal
Acute, traumatic massive tears
Massive tears are only exceptionally purely traumatic and often constitute case reports.36, 95 Massive trauma may exceptionally avulse the entire, healthy cuff or the cuff of a patient with predisposing factors such as severe osteopenia due to, for example, long-term administration of systemic steroid medication. Patients with a truly traumatic, massive tear present in the emergency department with a completely pseudoparalytic shoulder. Radiographic imaging excludes a fracture but may document
Nonoperative treatment
The value of nonoperative treatment using physical therapy or subacromial corticosteroid injection (which is also intra-articular in massive tears) is not well established.2, 12, 44, 55, 105 There is also no proof that conservative treatment substantially alters the course of the natural history of massive tears. In a small cohort, Zingg et al112 have documented a surprisingly good clinical outcome using nonoperative treatment but substantial structural deterioration of cartilage, tendon, and
Treatment algorithms
With precise understanding of the potential of the different treatment possibilities, a thorough evaluation of the patient’s symptoms and functional demands, and assessment of the reparability of the cuff, the most adapted treatment option is proposed to the patient following a treatment algorithm. We have found the algorithms presented in Figure 5, Figure 6 to be helpful. It is understood that during the course of treatment, a patient can change his or her decision because symptoms change from
Conclusion
There are currently multiple treatment options. Their technical details are described elsewhere, and often, the choice of the best treatment option is more difficult than the execution of a procedure. Therefore, a careful analysis of the patient’s situation and of the potential of the different treatment options is mandatory.
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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