I typically send them to PT for 2 weeks, rest, and treat with NSAIDs before I even do an MRI. Then only do MRI for failure to respond, then after MRI decide to refer or continue to treat with PT.
Surgery for an acute tear may be more appropriate but for some of these old chronic tendonitis/tears can be treated with PT/rest.
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.
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