Surgery vs. Physical Therapy for Shoulder Pain

Surgery And Physical Therapy Lead To Very Similar Outcomes
For Older Patients With A Rotator Cuff Tear

The shoulder is one of the most common sites for pain in the body, ranking only behind the back and knee in overall prevalence. Shoulder pain becomes even more common later in life, with many older adults complaining of restricted shoulder mobility that interferes with their ability to complete overhead tasks as they age.

Tears of the rotator cuff—a group of four muscles and tendons that wrap around the shoulder—are particularly common in this population, with about 30% of adults over the age of 60 experiencing this injury. Rotator cuff tears are associated with significant disability, and many patients therefore turn to surgery to alleviate pain and help them regain physical function. However, it’s unclear whether surgery leads to better outcomes than a nonsurgical approach such as physical therapy.

Physical therapy versus two surgical procedures

With this in mind, researchers performed a study to compare patients with a rotator cuff tear who had physical therapy to those who underwent one of two types of surgery. All 150 patients included were older than 55 years and had a confirmed, full-thickness tear of a rotator cuff tendon called the supraspinatus. Patients were then randomly assigned to one of three treatment groups: 1) physical therapy, 2) acromioplasty and physical therapy, or 3) rotator cuff repair, acromioplasty, and physical therapy.

Patients in the physical therapy treatment group were guided by a physical therapist through a standardized exercise training program that was to be completed at home. The first six weeks of the program aimed to increase the range of motion of the shoulder and then progressed to focus on muscle stability and function until the 12-week mark. Patients then increased the intensity of their strength training further for up to six months and participated in 10 in-person sessions with the physical therapist as a supplement to the at-home program.

The acromioplasty and physical therapy group underwent a procedure in which the acromion—a bony protrusion of the shoulder blade—is made smoother with surgical instruments. Afterwards, patients completed the same physical therapy program as the first group. The third group underwent a repair of the torn rotator cuff, plus the acromioplasty procedure, and then finally completed the physical therapy program. All patients were assessed before the interventions and then at regular intervals over five years for various outcome measures.

Patients should take into account these findings when considering surgery

After five years, there were no significant differences between patients in either of the three treatment groups, and surgically repairing the supraspinatus did not lead to any notable improvements, as researchers had expected. Therefore, according to these findings, it does not appear that surgery is any more effective for treating rotator cuff tears than physical therapy.

Seeing One of Our Physical Therapists is the Best First Choice

So if you’re dealing with shoulder pain and surgery is suggested as a possible avenue forward, we strongly recommend considering these findings and the limitations of a surgical approach when making your decision.

And for a hands-on, evidence-based, and personalized physical therapy treatment program for your shoulder pain, contact Bacci & Glinn Physical Therapy at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to schedule an appointment today.

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