The shoulder is a complex structure that consists of four joints that work together to allow for a large range of motion. Unfortunately, this flexibility results in instability and an elevated risk for injury. Perhaps the well-known shoulder injury is a rotator cuff tear, which will affect at least one-in-five persons during their lifetime. While some patients can recall a specific event that led to their injury, most rotator cuff tears occur over time and may even be present in the absence of symptoms. So, should an individual with a rotator cuff tear consult with a surgeon or explore non-surgical approaches first?
In a 2019 systematic review and meta-analysis that included 57 studies, researchers looked at the natural history of full-thickness rotator cuff tears that were treated surgically or non-surgically and found that both approaches led to similar improvements at three, six, and twelve months. In another systematic review that included ten studies, the investigators found that both surgery and non-surgical treatment provided similar outcomes with respect to range of motion, muscle strength, and quality of life. In yet another study, researchers observed that patients who delayed surgery for six months had better outcomes six-months post-op, leading the authors to suggest using that time to explore non-surgical options.
While the current research supports non-surgical treatments as an initial approach for rotator cuff tears, is it possible to know in advance which patients might experience slower improvement or not respond to care at all? In a 2021 study, researchers monitored 59 rotator cuff tear patients for two years following a course of conservative care and found that all patients experienced better outcomes at the one- and two-year time points; however, the data show that those with symptoms for longer than one year before seeking care, smokers, and those with significant fatty infiltration into the subscapularis muscle may experience slower improvement.
The bottom line is that outside of emergency necessity, patients with a rotator cuff tear should pursue non-surgical treatment as their first option, which includes chiropractic care. Doctors of chiropractic often use a multimodal approach that may include manual therapies, physiotherapy modalities, specific exercises, and nutritional recommendations. If necessary, they can co-manage a patient with their family doctor or a specialist.