Evaluation of interventions for rotator cuff pathology: a systematic review

A systematic review of published evidence was conducted investigating surgical and conservative management of rotator cuff disease. Medical databases searched included Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration library. Two independent reviewers evaluated each article for inclusion. Established criteria were used to assess the methodologic quality of articles examining outcomes of treatment interventions for rotator cuff disease. Due to the low methodologic quality of the studies that are currently available in this area, there is insufficient evidence to strongly support or refute the effectiveness of any available treatment intervention for rotator cuff pathology. The best available evidence supports open and primary surgery over arthroscopic debridement and revision surgery; and in the area of conservative management, electrotherapy, steroid use, exercise therapy, and acupuncture. There is a clear need for more methodologically sound studies to achieve strong evidence on which treatment practices can be based.