Managing the Patient
with Shoulder Pain

Shoulder pain is a common complaint seen by physicians and physical therapists. Rotator cuff disease (tendinopathies, partial or full-thickness rotator cuff tears, subacromial impingement) is the most common pathology affecting the shoulder. Varying degrees of rotator cuff tearing is demonstrated in 50-85% of patients with shoulder pain seen by health care providers.

Incidence increases with age, especially over age 60 (31%) and 80 (65%). So, how should we be managing these patients? Looking to the literature, some important factors should be considered.

• 80% of patients with rotator cuff tears are successfully managed with physical therapy (Dunn et al., 2016).
• The strongest predictor of failure of physical therapy intervention leading to subsequent surgical intervention is the patient’s expectations regarding physical therapy (Dunn et al., 2016).
• Patients had significant improvement in patient-related outcome scores at 6 and 12 weeks with physical therapy (Kuhn et al., 2013).
• 75% of patients with atraumatic full-thickness rotator cuff tears at 5 years were managing well without surgery (Kuhn et al., 2013).
• Of patients with shoulder pain associated with rotator cuff related disease or tears, 78% had successful management with an active 12-week progressive rehabilitation program, whereas 11% went on to have surgical intervention (Chepeha et al., 2020).
• After 13 years, 72% (n=103) of patients treated non-operatively reported continued pain relief and reported no problems with ADL (Kijima et al., 2012).
• Patients undergoing surgical and non-surgical management of rotator cuff tears demonstrate functional improvement (Moosmayer et al., 2010).
• Functional assessment scores are similar at 1 year after surgery and after rehabilitation alone (Kukkonen et al., 2015).
• The 5 year rate of treatment failure was the same for patients undergoing surgery and patients managed conservatively with PT (Moosmayer et al., 2010).

Non-operative management is successful in 75-85% of patients with shoulder pain associated with rotator cuff disease or tears.