University of Oulu

Cederqvist S, Flinkkilä T, Sormaala M, et al. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Annals of the Rheumatic Diseases 2021;80:796-802.

Non-surgical and surgical treatments for rotator cuff disease : a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

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Author: Cederqvist, Sanna1; Flinkkilä, Tapio2; Sormaala, Markus3;
Organizations: 1Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
2Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
3Department of Radiology, Helsinki University Hospital, Helsinki, Finland
4Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
5Research Center, Folkhälsan, Helsinki, Finland
6Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
7Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
8Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland
9Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
10Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
11Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
12Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
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Language: English
Published: BMJ, 2021
Publish Date: 2021-07-02


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:, NCT00695981 and NCT00637013.

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Series: Annals of the rheumatic diseases
ISSN: 0003-4967
ISSN-E: 1468-2060
ISSN-L: 0003-4967
Volume: 80
Issue: 6
Pages: 796 - 802
DOI: 10.1136/annrheumdis-2020-219099
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by grants from the Academy of Finland (grant 12321/13.9.2007) 265646/17.4.2013) and National Competitive Research Funding of the University of Eastern Finland. None of the writers have any conflicts of interest relevant to this article.
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.