Review: Management of Degenerative Rotator-Cuff Disorders
28 Nov, 2024 | 12:48h | UTCIntroduction: Degenerative rotator-cuff disorders are a leading cause of shoulder pain, especially in adults over 40 years of age, involving tendon degeneration from tendinopathy to full-thickness tears. Recognizing the need for clear clinical guidance, Jain and Khazzam provide a comprehensive review aimed at informing clinicians on evidence-based strategies for the evaluation and management of degenerative rotator-cuff tears to optimize patient outcomes.
Key Recommendations:
- First-Line Nonoperative Management: Initiate treatment with nonoperative measures, primarily structured physical therapy. The therapy should focus on strengthening periscapular muscles, correcting scapular posture, and improving rotator-cuff muscle strength and endurance. (Evidence Level: Expert consensus)
- Pharmacologic Therapy: Employ topical NSAIDs for pain relief due to their favorable safety profile. Oral NSAIDs may offer modest pain relief but should be used cautiously because of potential adverse effects. Opioids are generally not recommended due to associated risks and lack of superior efficacy. (Evidence Level: Moderate)
- Glucocorticoid Injections: Consider a single subacromial glucocorticoid injection to provide short-term pain relief, which may facilitate participation in physical therapy. (Evidence Level: Limited)
- Selective Imaging Use: Reserve imaging modalities like ultrasonography or MRI for cases with diagnostic uncertainty, potential surgical candidates, or when detailed assessment of tear extent and muscle degeneration is required. Routine imaging is not recommended in primary care settings. (Evidence Level: Consensus)
- Surgical Intervention Criteria: Surgery is not the initial treatment and should be considered for patients not improving with nonoperative measures. Factors favoring surgery include younger age, smaller tear size, and absence of significant psychosocial barriers. The decision should be individualized due to debated surgical indications. (Evidence Level: Observational studies)
- Avoidance of Unproven Therapies: Current evidence does not support the use of orthobiologic therapies, such as platelet-rich plasma or stem cells, in treating rotator-cuff disorders. (Evidence Level: Insufficient)
Conclusion: Implementing these recommendations can enhance patient care by emphasizing effective nonoperative strategies and judicious use of surgery for degenerative rotator-cuff disorders. Early initiation of physical therapy and appropriate pain management can lead to significant improvements in pain and function, potentially reducing the need for surgical intervention and improving patients’ quality of life.