I confess I do tend to worry a bit more than I should. Today I'm checking to see what happens if my torn rotator cuff doesn't get better with conservative care? What are my options then?
The rotator cuff is a group of four muscles with their tendons that surround the shoulder joint giving it both strength and stability. Without an intact rotator cuff, the shoulder can dislocate or may be so weak the person can no longer lift the arm up overhead or reach out to the side.
Rotator cuff tears are a common cause of shoulder pain, stiffness, weakness, and loss of motion and function. Treatment starts with conservative (nonoperative) care in physical therapy and/or with steroid injections. But in some cases, conservative care fails to reduce the painful symptoms or restore normal motion. That's when surgery may be needed.
Surgery to repair the damage is usually successful. But if you tend to worry, then your next question may be: what happens if conservative care fails AND surgery fails? Then what are your options?
Just as before, conservative care is the first line of treatment. It is still possible that a program of strengthening exercises combined with postural changes can bring about the changes you are looking for. But if a three-month trial of physical therapy and home program doesn't solve the problem, then you are probably looking at a second surgery.
The surgeon evaluates each patient in order to determine the most appropriate next step. It could be something as simple as a re-repair. The surgeon goes back in and resutures the torn tendon, stitiching the tear closed. This option isn't usually possible if there is poor tendon integrity, too many torn tendons, or too much fat replacing collagen (tendon) tissue.
Sometimes it's just a matter of going in and cleaning up frayed edges of tendon. This procedure is called debridement. At the same time, the surgeon may address lesions of the long head of the biceps tendon. Damage to the biceps (muscle that bends the elbow) is often associated with massive rotator cuff tears and may be responsible for chronic shoulder pain and dysfunction. The surgical procedure for biceps repair is called a biceps tenotomy or tenodesis.
The real key to determining what to do next depends on what is causing the persistent shoulder pain and symptoms. For example, without a normal healthy rotator cuff doing its job, the head of the humerus starts to move up putting pressure on the suprascapular nerve. Relieving tension on the nerve may reduce painful symptoms.
Some patients have massive tears that just can't be repaired. In such cases, the age of the patient may dictate the treatment. In younger patients, the surgeon can take another tendon nearby and transfer it to do the work of the torn rotator cuff. In older adults, a hemiarthroplasty or reverse shoulder arthroplasty are better choices.
Both of these procedures are a type of shoulder replacement. The hemiarthroplasty just replaces one side of the shoulder (usually the round head and attached neck of the humerus, the upper arm bone).
A reverse shoulder arthroplasty is a total shoulder joint replacement with a twist. Instead of the round head at the top of the humerus, the surgeon inserts a socket-shaped implant. The round portion fits where the natural socket used to be. This type of replacement surgery works well when the rotator cuff is so severely damaged it no longer functions to stabilize the joint.
But all that's way down the road from where you are at right now. It's good to be prepared for any possibility but the balance point is to take things as they come and do the best you can with what you have.
Ryan T. Bicknell, MD, MSc, FRCSC. Failed Rotator Cuff Surgery: What Can We Do? In Current Orthopaedic Practice. September/October 2010. Vol. 21. No. 5. Pp. 448-452.
*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.