, 2001) Therefore, other (non tendinous) sources causing the sym

, 2001). Therefore, other (non tendinous) sources causing the symptoms should also be taken into account before making the definite diagnosis. Second, little is known about the natural history of symptomatic or asymptomatic RotCuffTears. Therefore, more studies are needed to elucidate the long-term natural history of the different types of RotCuffTears. Third, various factors may influence the decrease of shoulder function in patients with a RotCuffTear. Both atrophy and fatty infiltration (identifying degenerative changes) are reported to give

poor prognosis for the return of rotator cuff see more function in these patients (Schaefer et al., 2002 and Goutallier et al., 2003). Furthermore, a massive RotCuffTear can cause cuff tear arthropathy (Feeley et al., 2009). Mechanical as well as nutritional factors

may also play a role in this process (Neer et al., 1983). The head of the humerus may migrate upward and may wear into acromion/acromio-clavicular joint and coracoid, resulting in cuff tear (mechanical) arthopathy or reduced motion (Neer et al., 1983). With disuse this can lead to osteoporosis and biochemical changes in the cartilage and cuff tear (nutritional) arthopathy (Jensen et al., 1999). Surgery might serve to stop this destructive process, but it is difficult to make an appropriate selection of patients who may (or may not) benefit from a surgical procedure based on the existing literature (Feeley et al., 2009). Additional studies are needed to identify pre-operative clinical prognostic factors in order to decide selleck inhibitor which patients are likely to respond to either non-surgical

or surgical treatment. Moreover, Isotretinoin information is needed that allows predicting which tears will progress and may need surgical intervention. One retrospective study (Maman et al., 2009) reported that progression of symptomatic RotCuffTear in patients treated non-surgical (physiotherapy, activity restriction, and selective corticosteroid injection) is associated with age over 60 years, a full-thickness tear, and fatty infiltration of the rotator cuff muscle(s). According to Zingg et al. (2007), satisfactory shoulder function in patients with a non-operatively managed, moderate, symptomatic massive RotCuffTear can be maintained for at least four years. Additional knowledge about pre-operative prognostic factors and outcome of non-operative treatment options of RotCuffTears may help professionals to decide which treatment may be most suitable for each individual patient. Some limitation of this review and its conclusions need to be addressed. First, we refrained from statistical pooling of the results of the individual trials; this was done because of the high heterogeneity of the trials.

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