September 24, 2020
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AAOS releases appropriate use criteria for management of full-thickness rotator cuff tears

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The American Academy of Orthopaedic Surgeons has released appropriate use criteria for the optimal management of symptomatic rotator cuff pathology, according to a release.

The appropriate use criteria (AUC), which is based on expert experience and literature review, provides updated treatment scenarios and guidance for decision factors related to adult full-thickness rotator cuff tears.

According to the AUC, the target patient group has the following indications:

  • a clinical history of anterolateral shoulder pain not radiating past the elbow;
  • weak rotator cuff strength, positive lift off or belly press test, external rotation lag, positive drop arm test upon and/or pain relief but sustained weakness after impingement test upon physical examination; and
  • radiographic findings consistent with full-thickness rotator cuff tear.

AAOS guidelines also state that the AUC may be applicable to concurrent diagnoses such as biceps tendonitis, labral fraying/tearing and acromioclavicular arthritis with osteophytes. However, the physician must determine that the rotator cuff tear accounts for most of the symptoms and that treatment of the secondary pathology is crucial to a positive surgical outcome.

The AUC is not intended for conditions such is rotator cuff retears, history of rotator cuff repair, partial-thickness tears, or rotator cuff tendonitis or bursitis. The AUC is specifically geared toward sports medicine and shoulder and elbow orthopedic surgeons, according to the release.

“The AUC tool offers accepted approaches to treatment and/or diagnosis and is not intended to be a fixed protocol,” according to the AAOS release. “Patient care and treatment should always be based on a clinician’s independent medical judgment, giving the individual patient’s specific clinical circumstances.”

Reference:

https://www.aaos.org/globalassets/quality-and-practice-resources/rotator-cuff/rcauc.pdf