Although both nonsurgical and surgical treatments are effective, a matched comparison study shows surgical treatment yields superior results

Many patients with rotator cuff disease do just fine with nonsurgical treatment that includes administration of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and physical therapy. Likewise, surgical treatment—including acromioplasty and rotator cuff repair—has also been found effective for most patients who receive it. But in a shoulder-to-shoulder match-up, how do these two different approaches fare?

According to the results of a retrospective study that matched patients demographically by age and gender, patients who received surgical treatment experienced a significantly greater reduction in pain, and a significant percentage of increase in function, than those in the nonsurgical group.

“It was our clinical observation that surgical results are superior to nonsurgical treatment in restoring function and reducing pain,” reported lead author Theodore A. Blaine, MD. “The study was therefore designed to compare nonsurgical and surgical treatment in a matched series of patients treated for rotator cuff disease at our institution.”

Defining the groups
From the patients who met the inclusion criteria, researchers matched—by age and gender—90 patients (92 shoulders) who had surgical treatment with 90 patients (92 shoulders) who were treated nonsurgically (Table 1). Most patients who were treated nonsurgically had symptoms for less than 6 months (62), while nearly half (43) of the patients who received surgical treatment had chronic symptoms lasting more than 6 months.

Based on available MRI data, researchers also determined that patients in the surgical group had more severe disease (longer symptom duration and larger rotator cuff tears) than those in the nonsurgical group. “Approximately half (49 percent) of patients were found to have full-thickness rotator cuff tears at the time of surgery,” they reported.

With these advanced disease characteristics, patients in the surgical group had higher initial pain scores and less function than those in the nonsurgical group. “An important finding is that, despite the more severe disease in patients who elect surgery, surgical treatment can decrease pain, improve function, and improve patients’ quality of life to a greater degree than nonsurgical treatment,” said the authors.

Determining the results
At a minimum 1-year follow-up, pain relief as measured by a visual analog scale (VAS) was significantly better in the surgical group relative to the nonsurgical group. “At the conclusion of treatment, 48 percent of patients in the nonsurgical treatment group had ‘no pain’ (VAS=0) as compared to 70 percent of patients who had ‘no pain’ in the surgical group,” reported Dr. Blaine.

Functional outcomes at a minimum 1-year follow-up were similar for both groups, but because the initial functional scores were worse for those who had surgery, the percentage improvement was higher for that group (Fig. 1).

“While the present study supports both nonsurgical and surgical treatment for improving pain and function in the treatment of rotator cuff disease, the most significant finding is the superiority of surgical over nonsurgical treatment,” summarized Dr. Blaine. “Based on this information, physicians may advise patients with rotator cuff disease (with or without rotator cuff tear) that both nonsurgical and surgical treatment may be successful.

“Surgical treatment, however, may be more successful in relieving pain, improving function, and improving overall quality of life when compared to nonsurgical treatment. This information may significantly affect the threshold at which the surgeon offers, and the patient considers, surgical treatment,” he concluded.

Coauthors of the paper include Jonathan E. Bell, MD; Jonathan D. Packer, BS; Jessica A. Lee, BS; Sarah Edwards, MD; Christopher S. Ahmad, MD; William N. Levine, MD; and Louis U. Bigliani, MD.