What are the guideline sources, guidelines and references for Rotator cuff injury ?
Guideline sources The following summarized guidelines for the evaluation and management of rotator cuff injury are prepared by our editorial team based on guidelines from the Canadian Shoulder and Elbow Society (CSES 2023), the American Academy of Orthopaedic Surgeons (AAOS 2020), the American College of Radiology (ACR 2018), and the Italian Society of Muscles, Ligaments and Tendons (ISMuLT 2016). 1 2 3 4 5 Guidelines 1. Classification and risk stratification Prognostic factors: Recognize that: older age is associated with higher failure rates and poorer patient-reported outcomes after rotator cuff repair A higher BMI is correlated with higher retear rates after rotator cuff repair surgery, but no correlation exists between higher BMI and worse patient-reported outcomes after rotator cuff repair B https://web.pathway.md/diseases/rec1UY8SBZh2jUF0d 1/5 6/24/23, 2:57 PM Rotator cuff injury Pathway the presence of a worker's compensation claim is associated with poorer patient-reported outcomes after rotator cuff repair A comorbidities are associated with poorer patient-reported outcomes B patients with diabetes will have higher retear rates and poorer quality of life and patient-reported outcome scores after rotator cuff repair B higher preoperative patient expectations for surgery correlates with higher patient-reported outcomes after rotator cuff repair. B 2. Diagnostic investigations Clinical examination: As per AAOS 2020 guidelines, perform clinical examination to aid in diagnosis and stratification of patients with rotator cuff tears. A As per ISMuLT 2016 guidelines, recognize that the clinical tests are not accurate in distinguishing rotator cuff disorders compared to other diseases in patients with suspected rotator cuff injury. Collect information about the mechanism of injury and type and onset of pain. A Diagnostic imaging: As per AAOS 2020 guidelines, obtain MRI, MRA, and ultrasound as adjuncts to a clinical examination for identifying rotator cuff tears. A As per ACR 2018 guidelines: Obtain shoulder X-ray as the initial imaging modality. B Obtain either MRI without IV contrast or ultrasound in patients with suspected rotator cuff abnormalities, if the initial radiographs are normal or inconclusive. B As per ACR 2018 guidelines, obtain MRI without IV contrast, magnetic resonance arthrography, or ultrasound in patients with physical examination findings consistent with a rotator cuff tear and normal radiographs. B As per ISMuLT 2016 guidelines, obtain conventional X-ray and MRI to provide additional details. A 3. Medical management Pain management: offer NSAIDs for short-term pain relief in patients with rotator cuff injury. B Management of unrepairable tears: consider offering physical therapy, biceps tenotomy/tenodesis, partial repair, tendon transfer, superior capsular reconstruction, arthroscopic d bridement, or allograft augmentation (nonporcine) to improve patient-reported outcomes in patients with unrepairable rotator cuff tears without arthropathy. E Show 2 more https://web.pathway.md/diseases/rec1UY8SBZh2jUF0d 2/5 6/24/23, 2:57 PM Rotator cuff injury Pathway 4. Nonpharmacologic interventions Physical therapy: recognize that both physical therapy and surgical management lead to a notable improvement in patient-reported outcomes in patients with symptomatic small-to-medium full-thickness rotator cuff tears. A Show 2 more 5. Therapeutic procedures Intra-articular corticosteroid injections: As per AAOS 2020 guidelines: Consider administering a single injection of corticosteroid with local anesthetic for short-term improvement in both pain and function in patients with shoulder pain. C Avoid administering multiple corticosteroid injections as this may compromise the integrity of the rotator cuff and affect attempts at a subsequent repair. D As per ISMuLT 2016 guidelines, offer corticosteroid injections to reduce pain and improve functions in patients with complete or partial rotator cuff tear. B Intra-articular hyaluronic acid injections: As per AAOS 2020 guidelines, consider administering hyaluronic acid injections in the nonsurgical management of patients with rotator cuff pathology. C As per ISMuLT 2016 guidelines, offer hyaluronic acid injections to reduce pain and improve functions in patients with complete or partial rotator cuff tear. B Intra-articular platelet-rich plasma injections: Avoid using platelet-rich plasma injections routinely for the treatment of patients with rotator cuff tendinopathy or partial tears. D Do not use platelet-rich plasma injections routinely in the nonsurgical management of patients with full-thickness rotator cuff tears. D 6. Surgical interventions Indications for repair: As per CSES 2023 guidelines, perform surgical intervention for traumatic rotator cuff tears within 12 weeks of injury or as soon as reasonably possible. B As per AAOS 2020 guidelines: Perform either conversion to full-thickness or transtendinous/in situ repair in patients with high- grade partial-thickness rotator cuff tears failed conservative management. A Insufficient evidence to recommend a preference for the choice of debridement versus repair of high-grade partial-thickness cuff tears failed physical therapy, but consider performing repair of high-grade partial tears to improve outcomes. I https://web.pathway.md/diseases/rec1UY8SBZh2jUF0d 3/5 6/24/23, 2:57 PM Rotator cuff injury Pathway Technical considerations for repair: As per CSES 2023 guidelines: Consider performing partial arthroscopic cuff repair, latissimus dorsi transfer, lower trapezius transfer, or superior capsular reconstruction in patients with massive tears of the rotator cuff. C Counsel patients with full-thickness tears of the rotator cuff seeking surgical intervention about the higher risk of objective failure regarding healing but similar patient-reported outcomes with single-row compared to double-row fixation in arthroscopic rotator cuff repair. B As per AAOS 2020 guidelines, perform either open or arthroscopic repair due to similar long- term (> 1 year) patient-reported outcomes or cuff healing rates, but prefer arthroscopic-only technique for better short-term improvement in postoperative recovery of motion and decreased VAS scores. A Show 4 more Graft augmentation: consider using dermal allografts to augment the repair of large and massive rotator cuff tears to improve patient-reported outcomes. C Show 2 more 7. Follow-up and surveillance Postoperative pain management: offer multimodal programs or nonopioid individual modalities to provide added benefit for postoperative pain management after rotator cuff repair. B Postoperative rehabilitation: Offer either early or delayed mobilization up to 8 weeks to improve postoperative clinical and patient-reported outcomes in patients with small- to medium-sized full-thickness rotator cuff tears after arthroscopic rotator cuff repair. A Consider offering supervised physical therapy rather than unsupervised home exercise in certain patients after rotator cuff repair. E Follow-up imaging: obtain either magnetic resonance arthrography, MRI of the shoulder without IV contrast, or ultrasound in patients with shoulder pain after rotator cuff repair, if the initial radiographs are normal or inconclusive. B References 1. Expert Panel on Musculoskeletal Imaging:, Kirstin M Small, Ronald S Adler et al. ACR Appropriateness Criteria Shoulder Pain-Atraumatic. J Am Coll Radiol. 2018 Nov;15 11S S388 S402. Open 2. Francesco Oliva, Eleonora Piccirilli, Michela Bossa et al. I.S.Mu.L.T Rotator Cuff Tears Guidelines. Muscles Ligaments Tendons J. 2016 Feb 13;5 4 227 63. Open 3. Stephen Weber, Jaskarndip Chahal. Management of Rotator Cuff Injuries. J Am Acad Orthop Surg. 2020 Mar 1;28 5):e193-e201. Open https://web.pathway.md/diseases/rec1UY8SBZh2jUF0d 4/5 6/24/23, 2:57 PM Rotator cuff injury Pathway 4. Peter Lapner, Patrick Henry, George Athwal et al. Position statement: management of rotator cuff tears in adults. Can J Surg. 2023 Apr 21;66 2 E190 E195. Open 5. Expert Panel on Musculoskeletal Imaging:, Behrang Amini, Nicholas M Beckmann et al. ACR Appropriateness Criteria Shoulder Pain-Traumatic. J Am Coll Radiol. 2018 May;15 5S S171 S188. Open https://web.pathway.md/diseases/rec1UY8SBZh2jUF0d 5/5