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Current Reviews in Musculoskeletal Medicine

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01-03-2018 | Rotator Cuff Repair (M Tao and M Teusink, section editors)

Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective

Authors: Ross Mathiasen, Christopher Hogrefe

Published in: Current Reviews in Musculoskeletal Medicine | Issue 1/2018

Abstract

Purpose of Review

To provide a primary care perspective regarding the evaluation and management of shoulder pain and rotator cuff tears.

Recent Findings

In the primary care setting, rotator cuff pathology is commonly encountered. Information regarding the risks of oral medications for the management of the associated pain keeps mounting. Partial-thickness rotator cuff tears remain difficult to diagnose with a single imaging modality. Musculoskeletal education in medical schools and non-orthopaedic residency and fellowship training programs continues to be an area for additional improvement.

Summary

In the primary care office, the initial evaluation of shoulder pain should include a thorough musculoskeletal evaluation in order to identify the source of the pain (e.g., shoulder, cervical spine, chest wall), as well as the development of an initial treatment plan. Access to imaging modalities such as ultrasound and MRI can vary depending on the resources available in the primary care setting. The identification of patients who may benefit from early surgical referral is imperative for optimizing outcomes.

Bishay V, Gallo RA. The evaluation and treatment of rotator cuff pathology. Prim Care. 2013;40(4):889–910, viii. https://doi.org/10.1016/j.pop.2013.08.006.CrossRefPubMed

Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford). 2006;45(2):215–21. https://doi.org/10.1093/rheumatology/kei139.CrossRef

Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124–8. https://doi.org/10.1136/bmj.331.7525.1124.CrossRefPubMedPubMedCentral

Cadogan A, McNair P, Laslett M, Hing W, Taylor S. Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care. J Man Manip Ther. 2013;21(3):148–59. https://doi.org/10.1179/2042618612Y.0000000020.CrossRefPubMedPubMedCentral

Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute shoulder injuries in adults. Am Fam Physician. 2016;94(2):119–27.PubMed

Titchener AG, White JJ, Hinchliffe SR, Tambe AA, Hubbard RB, Clark DI. Comorbidities in rotator cuff disease: a case-control study. J Shoulder Elb Surg. 2014;23(9):1282–8. https://doi.org/10.1016/j.jse.2013.12.019.CrossRef

Guyer C. Shoulder. In: Waterbrook A, editor. Sports medicine for the emergency physician: a practical handbook. Cambridge University Press; 2016.

van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Scholtes VA, Terwee CB, et al. The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear. J Orthop Surg Res. 2014;9(1):70. https://doi.org/10.1186/s13018-014-0070-y.CrossRefPubMedPubMedCentral

Eric H. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systemic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–78. https://doi.org/10.1136/bjsports-2012-091066.CrossRef

10.

Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol. 2006;187(2):376–82. https://doi.org/10.2214/AJR.05.0435.CrossRefPubMed

11.

Brockmeyer M, Schmitt C, Haupert A, Kohn D, Lorbach O. Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of the rotator cuff. Arch Orthop Trauma Surg. 2017;137(12):1719–24. https://doi.org/10.1007/s00402-017-2799-3.CrossRefPubMed

12.

Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;24:CD009020. https://doi.org/10.1002/14651858.CD009020.pub2.

13.

Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS One. 2017;12(6):e0178621. https://doi.org/10.1371/journal.pone.0178621.CrossRefPubMedPubMedCentral

14.

Fanelli A, Ghisi D, Aprile PL, Lapi F. Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications. Ther Adv Drug Saf. 2017;8(6):173–82. https://doi.org/10.1177/2042098617690485.CrossRefPubMedPubMedCentral

15.

Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. https://doi.org/10.1136/bmj.j1909.CrossRefPubMedPubMedCentral

16.

• Nissen SE, Yeomans ND, Solomon DH, Lüscher TF, Libby P, Husni ME, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375:2519–29. https://doi.org/10.1056/NEJMoa1611593. Discusses safety of celecoxib, naproxen, and ibuprofen including cardiovascular, renal, and intestinal outcomes. CrossRefPubMed

17.

Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042–9. https://doi.org/10.1136/bjsports-2014-093573.CrossRefPubMed

18.

Cole BF, Peters KS, Hackett L, Murrell GA. Ultrasound-guided versus blind subacromial corticosteroid injections for subacromial impingement syndrome: a randomized, double-blind clinical trial. Am J Sports Med. 2016;44(3):702–7. https://doi.org/10.1177/0363546515618653.CrossRefPubMed

19.

Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016;10:CD012224. https://doi.org/10.1002/14651858.CD012224.

20.

Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elb Surg. 2013;22(10):1371–9. https://doi.org/10.1016/j.jse.2013.01.026.CrossRef

21.

Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016;26(8):837–42. https://doi.org/10.1007/s00590-016-1826-3.CrossRefPubMed

22.

Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elb Surg. 2016;25(8):1303–11. https://doi.org/10.1016/j.jse.2016.04.030.CrossRef

23.

Kim YS, Kim SE, Bae SH, Lee HJ, Jee WH, Park CK. Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2073–80. https://doi.org/10.1007/s00167-016-4388-3.CrossRefPubMed

24.

• Cancienne JM, Brockmeier SF, Rodeo SA, Young C, Werner BC. Early postoperative fluoroquinolone use is associated with an increased revision rate after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2017;25:2189–95. https://doi.org/10.1007/s00167-016-4354-0. The first clinical study looking at postoperative fluoroquinolone use in relation to arthroscopic rotator cuff repair failure. CrossRefPubMed

25.

Cho NS, Moon SC, Jeon JW, Rhee YG. The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair. Am J Sports Med. 2015;43(4):991–7. https://doi.org/10.1177/0363546514565097.CrossRefPubMed

26.

Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005;87(2):310–4. https://doi.org/10.2106/00004623-200502000-00011.CrossRefPubMed

27.

• Day CS, Ho P. Progress of medical school musculoskeletal education in the 21st century. J Am Acad Orthop Surg. 2016;24:762–8. Discusses musculoskeletal education in medical schools and the need for continued evolution of this curriculum. CrossRefPubMed

Title: Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective
Authors: Ross Mathiasen
Christopher Hogrefe
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 1/2018
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9471-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation and Management of Rotator Cuff Tears: a Primary Care Perspective

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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