In this issue, we will discuss surgical treatment of the shoulder.Shoulder injuries have several causes, one of which is damage to the tendon of the shoulder, a tissue called the rotator cuff.This tissue, which comes up as a fundamental part of our knowledge of muscles and medical systems, is damaged in some way with decent frequency.If you think you have a frozen shoulder, it's actually this tissue. If you think you have a frozen shoulder, you actually have a partial tear of this tissue.The following is a review of whether or not you should have surgery for this disease that is encountered clinically and with some frequency. The following is a review of the study.
The study
This will be a review of nine studies, involving 1007 participants.
The average age of the participants ranged from 56 to 68 years old, with 29 to 56% female participants.
The participants had symptoms for months to years and were diagnosed with rotator cuff injuries by magnetic resonance imaging or ultrasound.
The study will be conducted in Finland, Norway, Canada, the United States, France, the Netherlands, Italy, and Korea.Our primary analysis included three trials with 339 participants who underwent either surgery (repair of the tendon and removal of bone from the undersurface of the acromion) or non-surgical treatment (exercise with or without glycocorticoid injections).Three studies were funded, but no studies reported direct use of funds for these trials.Compared to non-surgical treatment, surgical treatment has shown no benefit for people with rotator cuff tears.
In terms of pain (the lower the score, the less pain)
9 percent improved (4 to 13 percent improvement)
0.9 points on a scale of 0 to 10
Those who received non-surgical treatment rated their pain at 1.6 points.
Those who underwent surgical treatment rated their pain at 0.7 points.
Function (0 to 100; the higher the score, the better the function)
6% (2-10% improvement) or 6 points improvement on a scale of 0-100
Those who underwent non-surgical treatment scored 72 points.
Those who underwent surgical treatment scored 78 points.
Participant rate of global treatment success (are participants satisfied with the outcome?)
7% of participants rated the treatment as successful (4-13%)
or a result of 7 out of 100 people.
48/55 (873/1000)
Percentage of people who said they were successfully treated with non-surgical therapy
51/54 (943/1000)
Percentage of patients who were successfully treated with surgical treatment
Overall quality of life (a higher score means a better quality of life)
1% worse (4% worse to 2% better) or 1.3 points on a scale of 0 to 100
Those who underwent non-surgical treatment rated their quality of life at 58 points.
Those who underwent surgical treatment (subacromial decompression) had a quality of life rating of 57 points.
Adverse events
One adverse event (frozen shoulder) was reported in the exercise group.
However, no comparative risk can be estimated.
Serious adverse events
No serious adverse events were reported in these trials.
Reviewer's conclusion
Compared with nonoperative treatment, moderate certainty evidence (downgraded for risk of bias) indicates that surgery (rotator cuff repair with or without subacromial decompression) probably provides little or no benefit in pain, and low certainty evidence indicates that it may rotator cuff with a tear, little or no improvement in function, overall treatment success as assessed by the participant, or overall quality of life (reduced due to bias or imprecision). Because there is only one adverse event reported in the entire trial, it is not possible to estimate whether there is a higher risk of adverse events after any of the treatments (evidence of very low certainty).
Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Surgery for rotator cuff tears. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD013502. DOI: 10.1002/14651858.CD013502.
Conclusion
As a result, there is no solid evidence that surgical procedures are necessarily superior.Although there is some concern about the fact that different countries will have different results, people who have rotator cuff tears may want to look at these results and consider their treatment options.The choice of treatment will depend on the extent of the tear and the environment in which the patient lives, but both surgical and non-surgical treatments require patience.The results of this study were that people who work in the medical field would be happy to abuse the results, but I would recommend that you see a specialist to check the condition of the tear.
In my clinical experience, there was a person who was suspected of having a tear, but continued with conservative treatment because none of the diagnostic criteria applied to him.
