This is the 2010 AAOS clinical practice guideline on managing rotator cuff problems in adults. It systematically reviewed literature from 1966 through October 2008 to grade treatment recommendations. The guideline answers which rotator cuff interventions are actually supported by evidence and where the evidence is lacking.
When a patient presents with rotator cuff symptoms but no full-thickness tear, start with exercise and NSAIDs. This is one of only four moderate-grade recommendations in the entire guideline. The acromioplasty finding is high-yield for boards and practice. Two RCTs show no benefit to routine subacromial decompression during cuff repair, even with type II or III acromions.
The real teaching point is the state of the evidence: 19 of 31 recommendations were inconclusive. This reflects a quality deficit, not a lack of published studies. Know the negatives too. Avoid porcine SIS xenograft patches given the 20% to 30% hypersensitivity rate, and counsel workers' compensation patients that their status predicts less favorable outcomes.
Finally, for asymptomatic full-thickness tears, pain is the indication for surgery. Do not operate on an incidental tear in an asymptomatic elderly patient.
This is the 2010 AAOS clinical practice guideline on managing rotator cuff problems in adults. It systematically reviewed literature from 1966 through October 2008 to grade treatment recommendations. The guideline answers which rotator cuff interventions are actually supported by evidence and where the evidence is lacking.
When a patient presents with rotator cuff symptoms but no full-thickness tear, start with exercise and NSAIDs. This is one of only four moderate-grade recommendations in the entire guideline. The acromioplasty finding is high-yield for boards and practice. Two RCTs show no benefit to routine subacromial decompression during cuff repair, even with type II or III acromions.
The real teaching point is the state of the evidence: 19 of 31 recommendations were inconclusive. This reflects a quality deficit, not a lack of published studies. Know the negatives too. Avoid porcine SIS xenograft patches given the 20% to 30% hypersensitivity rate, and counsel workers' compensation patients that their status predicts less favorable outcomes.
Finally, for asymptomatic full-thickness tears, pain is the indication for surgery. Do not operate on an incidental tear in an asymptomatic elderly patient.