Is rehabilitation effective in massive rotator cuff tears?

BACKGROUND: Irreparable massive rotator cuff tears are challenging to treat. Our objective here was to evaluate the efficacy of a specifically designed rehabilitation programme.

HYPOTHESIS: We hypothesised that outcomes of the rehabilitation programme would vary with the site of the tears.

MATERIALS AND METHODS: Patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis were included prospectively. They followed a five-session specific rehabilitation programme. The outcomes were analysed according to the site of the tears.

RESULTS: We included 45 patients with a mean age of 67 years. At last follow-up after rehabilitation, 24 patients had recovered more than 160° of anterior shoulder elevation. Treatment failure was common in patients with massive anterior rotator cuff tears or tears involving three or more tendons. Patients with massive posterior tears, in contrast, often experienced substantial improvements, even in the medium term.

CONCLUSION: Outcomes of rehabilitation therapy in patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis vary according to the site and number of the tears. Failure of rehabilitation therapy is common in patients with massive anterior tears or tears involving at least three tendons. In contrast, in patients with isolated massive posterior tears, substantial benefits from rehabilitation therapy can be expected.

LEVEL OF EVIDENCE: III.