Comparative Effectiveness of Operative Versus Non-Operative Treatments for Rotator Cuff Tears

Rotator cuff tears account for over one quarter million surgeries annually. They are a
leading cause of shoulder pain and disability. Patients with rotator cuff tears present with
shoulder pain and/or limitation in range of motion. Fourteen special physical exam tests have
been described for diagnosis of rotator cuff tears. Prior literature describing sensitivity
and specificity of these tests in diagnosing cuff tears is limited by retrospective design,
small sample sizes, samples restricted to patients undergoing surgery, and failure to
differentiate between partial and full thickness tears. As a result, there is little evidence
to help clinicians interpret the diagnostic value of the clinical exam. Consequently,
clinicians rely heavily on magnetic resonance imaging (MRI) for diagnosing cuff tears, adding
considerable expense in the diagnostic process.

The treatment options for rotator cuff tears are operative and non-operative. There is
currently little consensus on indications and timing of rotator cuff surgery or non-operative
treatment. Furthermore, there is lack of evidence-based guidance on factors associated with
outcomes of operative versus non-operative treatment for cuff tears.

We are enrolling patients in a prospective cohort study to assess comparative-effectiveness
of operative versus non-operative treatment of rotator cuff tears and understand prognostic
factors for better outcomes after surgery and non-operative treatments.

Inclusion Criteria:

- Age 45 or older

- Symptoms for at least 4 weeks of shoulder pain and/or limitation in range of motion of
shoulder

Exclusion Criteria:

- History of humeral fractures

- Prior surgery on the same shoulder

- Contraindications to MRI (prior surgical hardware, pacemakers, defibrillators, and
claustrophobia)

- Unable or unwilling to give informed consent

- Unable or unwilling to be followed up

- Non-English speaking (as questionnaires have only been validated in English)