Purpose: To review the evidence for the effectiveness of therapeutic exercise for the treatment of full thickness (including massive and inoperable) tears of the rotator cuff.
Relevance: Although there are many surgical approaches for the management of full thickness rotator cuff tears, there is little consensus as to the most effective method for repairing massive cuff tears. There is a consensus that the outcome of rotator cuff tendon surgery in the elderly is generally very poor. As such, exercise therapy is usually recommended for this patient group. Although commonly prescribed the evidence to support this approach is equivocal. The aim of this study was to conduct a systematic review of the literature to determine the efficacy of exercise therapy for the management of full thickness rotator cuff tears.
Methods: A systematic review was conducted to synthesise the available research literature on the effectiveness of exercise therapy for full thickness tears of the rotator cuff.
Data Source: Reports up to and including September 2006 were located from MEDLINE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane Database of Systematic Reviews and the Physiotherapy Evidence Database (PEDro) using the terms “rotator cuff” and “tear/s” and “exercise” or “physiotherapy” or “physical therapy” or “rehabilitation”.
Study Selection: Studies were included if they related to full thickness rotator cuff tears and exercise.
Data Extraction: Two independent reviewers assessed the methodological quality of the studies. Differences were resolved by consensus.
Data Synthesis: 10 studies met the inclusion criteria. 8 studies were observational case series and 2 were single case studies. There were no randomized clinical trials.
Results: Only 4 studies were specific to massive rotator cuff tears. 1 study had a subgroup with massive cuff tears and 5 studies were not specific as to the size of the full thickness tear. Due to the heterogeneity of outcome measures used, it was not possible to combine results but in all studies patients showed an improvement in outcome scores. Exercise programmes were well documented in 5 studies.
Conclusions: No randomised controlled trials met the inclusion criteria and the evaluation has therefore been based on lesser quality observational studies. The findings suggest that some evidence exits to support the use of exercise in the management of full thickness rotator cuff tears. There is a definite need for well planned randomized controlled trials investigating the efficacy of exercise in the management of massive (inoperable) rotator cuff tears.
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