Nonoperative treatment of rotator cuff tears.

In this study, 33 patients with full-thickness tears of the rotator cuff were given a supervised nonoperative program of rotator strengthening exercises and then were seen at followup an average of 3.8 years later. Of the 14 patients who were dissatisfied with nonoperative care, 12 eventually had opted for surgery and 2 were dissatisfied with their status at followup. In attempting to identify patients who would benefit from nonoperative care, the authors were unable to show that individual parameters such as rotator strength, symptom duration, or functional impairment were useful to predict outcome. However, it was found that those who have an insurance claim or who experience significant sleep loss due to shoulder pain are unlikely to be satisfied with nonoperative treatment. Patient satisfaction with nonoperative treatment is best correlated with improved pain relief, the ability to carry a 10- to 15-pound suitcase at one's side, the ability to use the arm at shoulder level, and the ability to eat using a utensil. Objective variables such as rotator strength and active motion are not correlated with ultimate patient satisfaction.