Longo Umile Giuseppe, Franceschi Francesco, Berton Alessandar, Maffulli Nicola, Droena Vincenzo
Med Sport Sci. 2012;57:90-99. doi: 10.1159/000328910. Epub 2011 Oct 4.
There is no definite consensus on the best management for patients with rotator cuff tears. No randomized controlled studies have compared the outcome of surgical versus conservative treatment. The described successful rate of conservative treatment varies widely, from 33 to 92%. Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment of rotator cuff tears, non-operative management is often recommended in such patients. Prognostic factors seem to be clinical presentation, duration of symptoms and tear size. The best programme for conservative treatment is not defined. Physical therapy consists of stretching and strengthening exercises. The characteristics of exercise programmes are not standardized. In clinical practice, intra-articular injections are commonly used for treatment of shoulder pain. Systemic pharmacotherapy for patients with shoulder pain consists of non-steroidal anti-inflammatory drugs. Recently, cyclo-oxygenase-2-selective inhibitors have been introduced for management of shoulder pain. To date, few randomized controlled trials are available on conservative management of rotator cuff tears, and therefore further studies are required to clarify its role in such patients.
对于肩袖撕裂患者的最佳治疗方法，目前尚无明确的共识。尚无随机对照研究比较手术治疗与保守治疗的效果。所描述的保守治疗成功率差异很大，从33%到92%不等。尽管目前的证据不足以就肩袖撕裂的保守治疗得出明确结论，但对于此类患者通常仍建议采取非手术治疗。预后因素似乎包括临床表现、症状持续时间和撕裂大小。保守治疗的最佳方案尚未确定。物理治疗包括伸展和强化锻炼。锻炼方案的特点尚未标准化。在临床实践中，关节内注射常用于治疗肩部疼痛。针对肩部疼痛患者的全身药物治疗包括使用非甾体类抗炎药。最近，环氧化酶-2选择性抑制剂已被用于肩部疼痛的治疗。迄今为止，关于肩袖撕裂保守治疗的随机对照试验很少，因此需要进一步研究以阐明其在此类患者中的作用。
