To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.
In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.
A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.
The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.
Citations
Objective: To evaluate the effectiveness of conservative treatment for the vesicoureteral reflux (VUR) in spinal cord injured patients.
Method: Twelve spinal cord injured patients were diagnosed as VUR which was graded as the International Classification System by voiding cystourethrography (VCUG). They received conservative treatment including clean intermittent catheterization, administration of anticholinergics and intravesical oxybutynin instillation therapy. Pre-treatment urodynamic studies and VCUG were compared with follow-up studies after conservative treatment. The results of follow-up VCUG were graded as controlled or remained group.
Results: After conservative treatment, VUR was controlled in 8 patients (67.0%) and remained in 4 patients (33.0%). On urodynamic studies after conservative treatment, mean maximal bladder capacity increased from 225.0 to 370.6 ml (p＜0.05), mean bladder compliance increased from 12.1 to 31.5 ml/cmH2O (p＜0.05), mean maximal detrusor pressure decreased from 63.8 to 21.8 cmH2O (p＜0.05) in controlled group. But in remained group, there was no significant difference between pre & post-treatment. There was singnificant difference in change ratio of maximal detrusor pressure between two groups (p＜0.05).
Conclusion: This study showed 67.0% controlled rate of VUR by VCUG with improved urodynamic parameters after conservative treatment. We conclude that VUR can be effectively managed by the conservative method in spinal cord injured patients. (J Korean Acad Rehab Med 2002; 26: 299-305)
Objective: The purpose of this study was to evaluate and compare the natural course of morphologic changes and clinical outcomes between large central extruded disc herniation and sequestration.
Method: The study population consisted of 22 patients with sequestration and large central extrusion by an magnetic resonance (MR) imaging study. Seventeen (11 patients with sequestration, 6 patients with large central extrusion) patients underwent a follow-up MR imaging study. The size of herniated disc was measured on serial MR imaging studies and the change in size was classified into four categories. Clinical evaluations were also done using visual analogue scale (VAS), Oswestry low back pain disability questionnaire scoring, straight leg raising test (SLRT) and so forth.
Results: Successful clinical improvement was achieved in both groups. The VAS and Oswestry disability scoring established a greater change in the group with sequestration than in the group with large central extrusion. Greater morphologic decrease in the herniated discs occurred more frequently in sequestered disc herniation than large central extruded disc herniation.
Conclusion: Both sequestered disc and large central extruded disc herniation could be treated successfully by conservative treatment.
Objective: To document the outcome of the conservative treatment in plantar heel pain patients. Specific objectives included the evaluation the difference of outcome between patients, who revealed the different clinical menifestation, and the evaluation of prognostic factors.
Method: We devided the plantar heel pain patients to two groups by the location of maximal tenderness on the heel(Group A - localized severe tenderness over the medial calcaneal tuberosity, Group B - diffuse tenderness over the central heel) and performed the conservative treatment according to a standard protocol(relative rest,nonsteroidal anti-inflammatory medications and stretching exercise during initial 2 weeks. And then viscoelastic polymer heel cushion, functional custom-made insole for all patients. Steroid injections were used for the patients of Group A who suffer from pain despite of standard treatment. In order to evaluate the results, we reviewed all charts and conducted the follow-up survey by questionnairs. 21 patients(8 males, 13 females; 26 heels; average age, 47.9 years; 15 group A, 6 group B) were available for review.
Results: The average follow-up was 9 months. Clinical results were classified as good(resolution of symptoms) for 3 patients, fair(continued symptoms but no limitation of activity) for 13 patients, poor(continued symptoms limiting activity) for 5 patients. The overall successful improvement(including good and fair) were 76.2% within 2.6 months. There were no significant difference of the successful improvement between two groups, which were 73.3% in group A, 83.3% in group B. The overweight was the only predictive factor of poor result.
Conclusion: The outcome of a conservative treatment in patients with plantar heel pain is successful. But it is not different in spite of difference of clinical menifestation.
Objective: To clarify the relationship between the morphologic changes of disc herniation and the clinical course of conservatively treated herniated lumbar disc patients.
Method: Follow-up MRIs and clinical assessments by the Visual Analogue Scale and Japanese Orthopaedic Association(JOA) Score were performed in 20 patients at a mean interval of 11.3 month.
Results: An average reduction ratio of herniation on the sagittal and axial images, were 21.4% and 20.8% respectively. The clinical features improved significantly and the degree of clinical improvement correlated with the reduction ratio of herniation, althougy 4 patients improved symptomatically despite increased or unchanged degree of herniation. Ten patients with extruded discs showed a higher reduction ratio of heniation with better clinical outcome than those with protruded discs.
Conclusion: The morphologic change verified on MRI of conservatively treated patients with a lumbar disc herniation is responsible for the clinical outcome although the anatomical factor alone is not enough to explain the outcome. The patients with extruded disc herniation shows more morphologic changes on MRI and better clinical outcomes than the patients with protruded discs.
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