title: Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence.
abstract: BACKGROUND
  rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects.
  
  
  METHODS
  a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 - 1 December 2014), search terms: 'rotator cuff tear', 'natural history', 'atraumatic', 'injection', 'physiotherapy' or 'physical therapy', 'injection', 'corticosteroid', 'PRP', 'MSC', risk of conservative treatment', and 'surgical indication'.
  
  
  RESULTS
  eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88-44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome.
  
  
  CONCLUSIONS
  complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy.
authors.affiliation: Mediclinic City Hospital, Dubai, United Arab Emirates.
authors.forename: Taiceer A
authors.initials: TA
authors.lastname: Abdul-Wahab
authors.affiliation: Vanderbilt University School of Medicine, Nashville, USA.
authors.forename: Jean P
authors.initials: JP
authors.lastname: Betancourt
authors.affiliation: Hull York Medical School, North Yorkshire, UK.
authors.forename: Fadi
authors.initials: F
authors.lastname: Hassan
authors.affiliation: Orthocure Medical Center, United Arab Emirates University, Dubai, United Arab Emirates.
authors.forename: Saeed Al
authors.initials: SA
authors.lastname: Thani
authors.affiliation: Physioart Centre, Dubai, United Arab Emirates.
authors.forename: Hened
authors.initials: H
authors.lastname: Choueiri
authors.affiliation: Vanderbilt University School of Medicine, Nashville, USA.
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, USA.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Malanga
authors.affiliation: Department of Orthopaedic Sports Medicine, Dr. Humeira Badsha Medical Center, Dubai, United Arab Emirates, and Department of Orthopaedics, Rehabilitation, and Pediatry, Ft. Belvoir Community Hospital, Ft. Belvoir, Virginia, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Murrell
authors.affiliation: Osteopathic Health Centre, Dubai, United Arab Emirates.
authors.forename: Anil
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Az Monica Hospital, Antwerp, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Verborgt
keywords: natural history; physiotherapy; risk; rotator cuff