Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I am someone I always describe as a "minimalist" when it comes to dental work or medical problems. So when my orthopedic surgeon suggested debridement instead of a complete surgical reconstruction of a torn rotator cuff, I said 'yes'! But now I'm 24-hours away from the surgery and having second thoughts. Is this really the best way to go?

Answer:

When it comes to treatment of rotator cuff tears, this is a question many surgeons and patients face. Many studies have been done comparing the results of one method over another. There is general consensus that the first step is a course of conservative (nonoperative) care. Conservative care often starts with the use of antiinflammatory medications. Physical therapy to correct posture and alignment as well as address loss of motion, weakness, and impaired function is important, too. The surgeon may recommend a steroid injection if there is improvement but continued pain or no improvement at all. If these efforts fail then surgery is considered. It sounds like that's where you are at right now. Surgery usually goes one of three ways: debridement, partial repair, or complete repair. 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 first advantages of debridement is that it is noninvasive. The procedure can usually be done arthroscopically. A small incision is made and a tiny fiberoptic video camera inserted into the joint gives the surgeon the ability to complete the debridement process. Arthroscopic debridement can be done on an outpatient basis which tends to lower the costs. There are fewer complications after debridement (compared with partial or complete repair procedures). And rehab is shorter so there's less risk of developing a frozen shoulder. You'll be able to get back to your daily activities faster. On the downside, there is the risk of reinjury with further damage and tearing of the remaining rotator cuff. But if that happens, then you will be re-evaluated as a potential patient for full reconstructive surgery. 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. 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 surgeon is really the best one to advise you on the most appropriate surgical procedure to perform. The final decision is often made at the time of the actual procedure when the surgeon can see the location and severity of the lesion (tear). 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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