I have recently had a number of individuals with RCTs that have had significant findings suggestive of their tears being much older than their acute injury. There is a large amount of research validating the presence of non-acute partial and full thickness tears which are asymptomatic, esp. as we age. On top of that, a significant number of tears can be managed successfully with PT providing outcomes as good or better than surgery. How are other providers handling RCTs and are the employers aggressively trying to determine the age of tears prior to treatment?  Roger

Thanks Ed, yes I agree to wait on MRIs, in fact I may wait as long as 6 weeks depending on how they are responding to PT. Younger adults who appear to have tears I am generally more aggressive with but still will try Physical therapy depending on symptoms. I will be writing an article on this subject for the AAPA OM newsletter and am trying to gather some info. from other practitioners on their treatment protocols prior to that.

 My concern is that we are doing surgery on work comp. injury RCTs that are #1 not necessary for recovery, #2 being performed on individuals whose tear is obvious but is old and not related to the acute injury,#3 not appropriately using therapy prior to ortho. referral.

We should be aggressively screening out old tears in WC shoulder injuries that are not related to the acute injury but may have only aggravated it and then treat appropriately to baseline.