Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I'm so glad I found your website. I've been searching all weekend for help deciding what to do about my rotator cuff tear. I'm not particularly happy to think I might have surgery that could put me out of commission for six months. And there's so much information out there, I don't know how to judge what will work best. I'm 75-years-young and I have had this problem a long time. The surgeon says it's likely a "massive" tear.

Answer:

Orthopedic surgeons from around the world continue to look for ways to improve results of surgery for rotator cuff tears (RCTs) of the shoulder. Of special interest are the results of surgery for massive RCT tears like yours. The rotator cuff is formed by the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the humerus to the scapula. The rotator cuff helps raise and rotate the arm. The typical patient with a rotator cuff tear is in late middle age and has had problems with the shoulder for some time. This patient then lifts a load or suffers an injury that tears the tendon. After the injury, the patient is unable to raise the arm. However, these injuries also occur in young people. Overuse or injury at any age can cause rotator cuff tears. A recent study from Germany addresses the question of what surgical treatment works best: complete repair, partial repair, or just debridement. Debridement refers to a surgical procedure in which the surgeon cleans the area of debris and torn fragments. The rotator cuff is then left to heal on its own. There are pros and cons to each technique. The results of this study confirmed what others have said, too. First, the type of surgery (debridement, partial repair, complete repair) is usually decided during surgery. When the surgeon can see the location and severity of the lesion (tear) then the final decision is made. Partial-thickness tears and full-thickness tears can often be repaired if the damage isn't too much. But massive, full-thickness tears may be too much to allow for any kind of repair. That's when debridement is done instead. In the German study, the results (joint motion, function) were measured and compared before and after surgery for massive rotator cuff tears in 72 older adults. The good news is that everyone in all three groups improved. They had less pain after surgery, more motion, and could use the arm more. A closer look at the data showed that the patients in the complete repair group had the best results. They seemed to gain more active (patient-controlled) shoulder motion afterwards. And more motion translated into better daily function. Taking a look at the results for partial repair versus debridement, there was no difference between the groups. The results of this study are important when considering treatment of a complete rupture of the rotator cuff. Studies have shown that tears can be so massive that surgery won't help. Re-rupture after rotator cuff tear is fairly common. No one wants to go through major surgery and a long rehab program only to retear the cuff. Knowing that a complete repair yields the best results helps guide the surgeon when selecting the right course of action for each patient. It is still true that the best results occur with repair of small or moderate tears of the rotator cuff. The size of the tear really does predict the outcomes. The larger tears tend to fill in with fat and scar tissue making surgical repair more difficult. The tendon can retract (pull away) so far that it cannot be restored to its correct anatomical insertion. Poor quality of the torn rotator cuff is another factor the surgeon considers when deciding what type of surgery to perform. Your efforts to gain knowledge and understanding of your situation are commendable. This information will help you when the surgeon explains the planned surgery. It will also help appreciate if changes are made in what is actually done occur during the operation. Alexander Berth, MD, et al. Chronic Rotator Cuff Tears: Debridement Versus Complete Versus Partial Repair. In Journal of Orthopedics. 2011. Vol. 8. No. 3. Pp. e10.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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