Tratamento conservador ou intervenção cirúrgica?: critérios clínicos para a seleção da abordagem terapêutica em lesões sintomáticas no manguito rotador

Abstract

The most common cause of disability related to shoulder dysfunction are changes in the rotator cuff. The literature shows high incidence and prevalence of this type of injury, and the great functional impact of it. However, there are still differences in clinical decision making for their treatment. The aim of this study is to identify the criteria used by doctors and physiotherapists for the indication of treatment for patients with symptomatic rupture in the rotator cuff. A literature review was performed in PUBMED and SCIELO databases. The search terms were: physicians practice patterns AND decision making OR physical therapy modalities AND rotator cuff for PUBMED e manguito rotador for SCIELO The search period was between February and August 2015. The studies presented indication of the therapeutic approach in symptomatic individuals with rotator cuff tear were included. 12 articles were selected. After analyzing these, it was observed that surgeons use the ability of tissue repair, the susceptibility of the progression of break and own clinical experience to refer patients. Already physiotherapists are based on the possibility of modifying factors related to the function and shoulder biomechanics in patients with poor prognosis for surgical repair and acceptance of the patient about the results. Both surgeons and physiotherapists try to use the weakness and loss of function instead of pain. The decision regarding the indication of treatment of rotator cuff tear should be individualized and patient-centered, considering the function, the ratio of demand and physical capacity and short and long term goals. Treatment decisions should not be guided only by the clinical experience of the professional, but also in practice based on evidence.