Treating Minor Rotator Cuff Tears: When Less Is MoreLike most injuries, tears to the rotator cuff--the tendons that surround and support the shoulder joint--are a matter of degrees. If the tear is slight, involving less than a quarter of the tendon, it is called a "grade 1 tear." If the tear is medium-sized, involving more than a quarter but less than half of the tendon, it is a "grade 2 tear." If the tear goes through more than half of the tendon, it is a "grade 3 tear."
Deep tears must be repaired or stitched back together in order for the shoulder to function properly. But another treatment called acromioplasty may be sufficient for minor tears. With acromioplasty, surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. This takes pressure off the injured rotator cuff and promotes healing.
Acromioplasty can be done using an arthroscope. This slender instrument has a camera on the end that can be inserted through a small incision to let the doctor operate. Arthroscopic acromioplasty is a less invasive procedure than rotator cuff repair. But is it successful for patients with grades 1 and 2 tears?
One hundred patients had arthroscopic acromioplasty. Some of the patients had shoulder impingement, meaning the tendon was pinched, without rotator cuff tears. Some of the patients had grade 1 tears. Most of the patients had grade 2 tears. The patients had all tried nonoperative treatment such as exercises and medications without success.
How did patients fare with acromioplasty? Overall, the results were excellent. Patients with rotator cuff tears did just as well as those without tears. About five years after acromioplasty, most patients had little or no pain, and good shoulder strength and motion. These results were stable over time. Patients did not develop shoulder problems later on, as some researchers worried they might.
Treatment was considered to have failed in eight patients (eight percent). These patients had persistent pain after surgery that did not change over time. Most of the failures happened to patients with grade 2 tears. Failures were also more common when the tear was located on the top surface of the tendon.
Acromioplasty is a reliable treatment for shoulder impingement and minor (grades 1 and 2) rotator cuff tears. Most patients have immediate relief from this procedure. When the treatment fails, it fails early, and the results do not change over time. Failures may be more likely for patients with grade 2 tears in the top surface of the tendon. These tears should probably be sutured together rather than treated only with acromioplasty.
Frank A. Cordasco, MD, et al. The Partial-Thickness Rotator Cuff Tear: Is Acromioplasty Without Repair Sufficient? In The American Journal of Sports Medicine. March/April 2002. Vol. 30. No. 2. Pp. 257-260.
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