Rotator cuff disease: opinion regarding surgical criteria and likely outcome

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Shoulder pain due to rotator cuff disease (RCD) is a frequently reported musculoskeletal complaint, with prevalence rates reported to be as high as 36% during adult life.1 Surgery may be indicated after failure to respond to a conservative program that can include pharmacology, injection therapy, physiotherapy and exercise rehabilitation.
Surgical criteria for RCD are not clear, with clinical practice guidelines and surveys of surgeon opinion outlining a lack of consensus agreement between surgeons for the management of RCD.2 Evidence‐based clinical guidelines, surgeon education, surgeon personal experience and individual patient factors, may inform surgical decision‐making. The lack of robust clinical guidelines is a result of limited high quality evidence.2
Clinical examination tests, such as weakness or pain on muscle testing4 or clinical orthopaedic tests6 may assist with decision‐making, however tests also lack robust evidence. A systematic review determined that most tests for RCD are inconclusive, with limited recommendation for their clinical use.9
Surgical views may be similar in the Australian orthopaedic community as the USA and UK, however surgeon opinion in Australia has not been reported. The aims of this study were to survey Western Australian (WA) orthopaedic surgeons for opinions regarding (i) indications for rotator cuff surgery; (ii) physical examination tests most commonly utilized; (iii) findings at surgery that may be predictive of outcome; and (iv) what constitutes a successful surgical outcome.
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