EXERCISE THERAPY IN THE NON-OPERATIVE TREATMENT OF FULL-THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW.

Area of Science:

• Orthopedics
• Physical Therapy
• Sports Medicine

Background:

• Conservative management and exercise therapy (ET) are common for full-thickness rotator cuff tears (FTT).
• However, the evidence supporting these treatments remains equivocal.

Purpose of the Study:

• To systematically review the literature on the evidence for ET in FTT treatment.
• To provide a formal GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendation.

Main Methods:

• A systematic literature search was conducted across five databases for studies on ET effectiveness in FTT.
• Inclusion criteria focused on adult FTT patients receiving ET, excluding surgical repair or significant trauma.
• Studies were assessed for quality, level of evidence (I-V), and GRADE recommendation (A-F).

Main Results:

• 35 studies (9 RCTs, 6 cohort, 15 case series, 5 case reports) involving 2010 shoulders were included.
• Non-operative ET showed improvements: 78% in pain, 81% in ROM, 85% in strength, and 84% in function.
• 15% of patients dissatisfied with conservative care eventually transitioned to surgery.

Conclusions:

• Current literature supports a GRADE B recommendation (moderate strength) for ET in FTT management.
• Further well-designed randomized controlled trials are necessary to strengthen the evidence base.