PT  - JOURNAL ARTICLE
AU  - Sanna Cederqvist
AU  - Tapio Flinkkilä
AU  - Markus Sormaala
AU  - Jari Ylinen
AU  - Hannu Kautiainen
AU  - Tero Irmola
AU  - Heidi Lehtokangas
AU  - Juho Liukkonen
AU  - Konsta Pamilo
AU  - Tero Ridanpää
AU  - Kai Sirniö
AU  - Juhana Leppilahti
AU  - Ilkka Kiviranta
AU  - Juha Paloneva
TI  - Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation
AID  - 10.1136/annrheumdis-2020-219099
DP  - 2021 Jun 01
TA  - Annals of the Rheumatic Diseases
PG  - 796--802
VI  - 80
IP  - 6
4099  - http://ard.bmj.com/content/80/6/796.short
4100  - http://ard.bmj.com/content/80/6/796.full
SO  - Ann Rheum Dis2021 Jun 01; 80
AB  - Background Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear.Methods In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up.Results At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery.Conclusions Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment.Trial registration details ClinicalTrials.gov, NCT00695981 and NCT00637013.Data sharing not applicable as no data sets generated and/or analysed for this study. Study data cannot be shared publicly because of confidentiality requirements under Finnish law. De-identified patient data is available from the study group and from Central Finland Hospital (contact via www.ksshp.fi, juha.paloneva@ksshp.fi) for researchers who meet the criteria for access to confidential data.