I saw my orthopedic surgeon last week about having my very large rotator cuff tear repaired. I'm still mulling over the advice I got and that was: the tendon might not heal even with surgery but I might get some pain relief and better motion. And that means I might get some better use of the arm. I think the surgeon used the word "function" rather than "better use" -- that was my take on it. What do you think? Are all those mights worth taking the risk?
As you have been told, adults with very large tears of the rotator cuff (four tendons/muscles surrounding the shoulder) can get pain relief and improved function after surgical repair -- even if the tendon doesn't heal. These are the results of a small study of 15 to 18 patients who were followed over a two to 10 year period of time.
Results were reported two years after the arthroscopic repair in the first study by the same authors of this second study (with the same group of patients). Outcomes were re-measured 10 years after the primary (first) surgery using ultrasound studies and patient self-report of pain, motion, and function. That's when the surgeons discovered two things.
First, the results were the same at the 10-year post-operative time as compared with results two years after the surgery. That means the patients were able to maintain outcomes without further decline. And second, a failed healing in 17 of the 18 patients didn't keep them from improving and holding that improvement steady over the years.
X-rays and ultrasound studies done on 11 of the original 18 patients confirmed the continued presence of rotator cuff tears. In a couple of patients, the tear was worse. There was no change in four shoulders and four patients actually had a decrease in the size of the tear. In all 11 cases, the head of the humerus had migrated (moved) up out of the natural resting place where it should be in the shoulder socket.
The bottom-line is that despite evidence of worsening of the soft tissues and shoulder joint, the majority of patients still had improvements with the surgery. Although the unhealed repair allows for continued function, the shoulder was not protected from further degenerative changes.
Other studies have shown that with severe rotator cuff tears, the damaged area fills in with fatty tissue. It's not clear yet what effect this fatty atrophy will have in the long-run but researchers will continue to study these patients to find out. Osteoarthritic degeneration and function in unhealed shoulder cuff tendons will be the focus of other future studies as well.
Experts advise that patients with severe or "massive" tears of the rotator cuff tendon should be informed that surgery may fail to create a healing response. But the pain relief offered and improved motion and function may make it worth having the procedure anyway. It sounds like your surgeon is up-to-date with this information and providing it to patients appropriately.
According to this study, improvements seem to last for up to a decade (10 years) even when there is evidence of ongoing degeneration of the soft tissues. In older adults who are not in need of full strength and motion, surgical repair of a torn rotator cuff may still be beneficial because healing is not needed for a successful result.
E. Scott Paxton, MD, et al. Clinical and Radiographic Outcomes of Failed Repairs of Large or Massive Rotator Cuff Tears. Minimum Ten-Year Follow-up. In The Journal of Bone and Joint Surgery. April 2013. Vol. 95A. No. 7. Pp. 627-632.
*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.