Living With a Symptomatic Rotator Cuff Tear
Living With a Symptomatic Rotator Cuff Tear
Around 1% of adults aged over 45 years consult their General Practitioner for a new shoulder problem annually; estimations of shoulder pain prevalence range from 4–26%, and rotator cuff problems account for more than two thirds of cases. Shoulder problems are often long term; the majority of people referred to primary care with first episode shoulder pain remain symptomatic one month later and 41% experience persistent symptoms at twelve months. Rotator cuff tears increase with age and may be symptomatic or asymptomatic. 26.2%-38.9% of rotator cuff tears demonstrated during radiological investigations of the shoulder are asymptomatic, although tears may become symptomatic over time. Economically, in addition to health care consultation and treatment costs, work related upper limb disorders in the UK are now more prevalent than back pain.
The rotator cuff is a critical component of shoulder function and for the successful completion of manual tasks requiring the ability to position the hand precisely in space, particularly when the arm is away from the body. There is a lack of concensus regarding the optimal treatment of degenerate cuff tears and limited and inconclusive evidence regarding the relative effectiveness and harms of surgical and conservative treatment approaches. Non-operative management such as physiotherapy is recommended prior to considering surgery but surgical referral criteria are not straightforward. The need for further research was highlighted at a recent consensus meeting on the management of disorders of the rotator cuff which identified 30 unresolved issues/areas for future research to improve management.
There is also an absence of information about symptomatic rotator cuff tears from the patients' perspective which limits the information clinicians can share with patients. The value of qualitative research to improve understanding of patients' experiences, and of the complex processes involved in treatment outcomes, is well recognized and accepted. One recent Finnish study describes the experience of patients' diagnosed with supraspinatus tendonitis problems, reporting pain as the predominant attribute of shoulder problems (six focus groups, three pre and three post different types of treatment (n = 21) individuals). More widely, reports include a study briefly exploring patients' experiences of frozen shoulder and treatment via the Bowen technique, a reflection upon the importance of the interpersonal nexus within qualitative research processes with patients undergoing shoulder surgery and a study of patients' perceptions and priorities regarding frozen shoulder. However, qualitative research regarding rotator cuff tears remains highly limited.
The United Kingdom Rotator Cuff Surgery Trial (UKUFF) was funded by the NIHR Health Technology Assessment Programme to examine the clinical and cost effectiveness of different surgical techniques versus non-surgical treatment for rotator cuff tears. A qualitative study was undertaken to explore UKUFF participants' experiences of having a known rotator cuff tear and to explore their treatment decision making experiences and outcome. This article aims to describe the experiences of people with a known rotator cuff tear, their symptoms and the impact upon their daily lives and the coping strategies utilised by participants.
Background
Around 1% of adults aged over 45 years consult their General Practitioner for a new shoulder problem annually; estimations of shoulder pain prevalence range from 4–26%, and rotator cuff problems account for more than two thirds of cases. Shoulder problems are often long term; the majority of people referred to primary care with first episode shoulder pain remain symptomatic one month later and 41% experience persistent symptoms at twelve months. Rotator cuff tears increase with age and may be symptomatic or asymptomatic. 26.2%-38.9% of rotator cuff tears demonstrated during radiological investigations of the shoulder are asymptomatic, although tears may become symptomatic over time. Economically, in addition to health care consultation and treatment costs, work related upper limb disorders in the UK are now more prevalent than back pain.
The rotator cuff is a critical component of shoulder function and for the successful completion of manual tasks requiring the ability to position the hand precisely in space, particularly when the arm is away from the body. There is a lack of concensus regarding the optimal treatment of degenerate cuff tears and limited and inconclusive evidence regarding the relative effectiveness and harms of surgical and conservative treatment approaches. Non-operative management such as physiotherapy is recommended prior to considering surgery but surgical referral criteria are not straightforward. The need for further research was highlighted at a recent consensus meeting on the management of disorders of the rotator cuff which identified 30 unresolved issues/areas for future research to improve management.
There is also an absence of information about symptomatic rotator cuff tears from the patients' perspective which limits the information clinicians can share with patients. The value of qualitative research to improve understanding of patients' experiences, and of the complex processes involved in treatment outcomes, is well recognized and accepted. One recent Finnish study describes the experience of patients' diagnosed with supraspinatus tendonitis problems, reporting pain as the predominant attribute of shoulder problems (six focus groups, three pre and three post different types of treatment (n = 21) individuals). More widely, reports include a study briefly exploring patients' experiences of frozen shoulder and treatment via the Bowen technique, a reflection upon the importance of the interpersonal nexus within qualitative research processes with patients undergoing shoulder surgery and a study of patients' perceptions and priorities regarding frozen shoulder. However, qualitative research regarding rotator cuff tears remains highly limited.
The United Kingdom Rotator Cuff Surgery Trial (UKUFF) was funded by the NIHR Health Technology Assessment Programme to examine the clinical and cost effectiveness of different surgical techniques versus non-surgical treatment for rotator cuff tears. A qualitative study was undertaken to explore UKUFF participants' experiences of having a known rotator cuff tear and to explore their treatment decision making experiences and outcome. This article aims to describe the experiences of people with a known rotator cuff tear, their symptoms and the impact upon their daily lives and the coping strategies utilised by participants.
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