Do you have shoulder pain to the point that you’re considering surgery? Now more than ever people are deciding to skip the surgery and try less invasive solutions. How do you know which option is best for you? This is a common question we get here at Nashville Regenerative Orthopedics. To answer, I am going to cover some basics.
Rotator Cuff Tear – What is it?
The rotator cuff muscles and tendons surround the shoulder joint and move it, as well as stabilize it. There are four muscles which include, from front to back:
- the Subscapularis,
- the Supraspinatus,
- the Infraspinatus, and,
- the Teres major/minor.
The tendons can get injured or torn due to trauma or age. This can cause pain with shoulder movement and if physical therapy doesn’t help, surgery has often been the next recommended step.
How Does Rotator Cuff Surgery Work?
During surgery, the tear in your rotator cuff is sewn together surgically. If needed, anchors will be used to adhere the tendon to the bone. An acromioplasty can often also be performed – this where one of the bones of the shoulder is shaven down to make more room for the rotator cuff.
Below you can see images of the types of Rotator Cuff tears.
There are different types of rotator cuff tears:
- Partial Tear(second image above). This is where a part of the tendon has been torn, usually the top (bursal side) or bottom (articular side). The partial tear can also be inside the tendon, in which case it’s called interstitial or intrasubstance.
- Complete Non-retracted Tear(third image above). This type has many small tears throughout the whole tendon, but it’s still held together as one piece. Regrettably, many MRI reports don’t point this type out clearly.
- Complete Retracted Tear(fourth image above). This is also called a massive rotator cuff tear. The tendon is completely torn and pulled back like a rubber band.
Is Shoulder Surgery the Right Solution for You?
All three forms of a tear are candidates for surgery, however research has shown that surgery for a partial tear produces no better outcome than physical therapy. So, if you have a partial tear, I would not recommend surgery.
Surgery may be needed in larger rotator cuff tears. However, the problem of retear exists – and at a high rate. Studies have shown as high a rate as 60% re-tear post-surgery.
One potential way to avoid retears is by utilizing your own bone marrow concentrate (containing stem cells) during recovery. A controlled study conducted in 2014 found 87% of patients utilizing bone marrow MSC (Mesenchymal Stem Cells) had an intact rotator cuff 10 years post-surgery.
Many surgeons recommend surgery for the middle category – complete non-retracted tear. However, there is information suggesting that injecting PRP or bone marrow concentrate into the tear can help avoid surgery by stimulating the tendon to heal itself.
On the Wellness Hour, I explained this. Watch below.
How Long Can You Wait to Have Rotator Cuff Surgery?
You can generally wait a few months before getting rotator cuff surgery. However, we know that they generally get bigger over time. Further, many rotator cuff tears are present for years before being surgically repaired.
Can a Completely Torn Rotator Cuff Heal without Surgery?
Partial tears can heal with just physical therapy. While complete non-retracted tears are less likely to heal on their own, with guidance and proper treatments you can reduce the pain and regain function. Complete retracted tears (massive tears) do not heal on their own. But even in these situations you still can decrease pain and improve function with proper applications of regenerative medicine.
As an orthopedic surgeon, it is my job to help my patients regain function and mobility. I want to take the best course with each patient. I do my best to help patients avoid surgery where possible. Where surgery can’t be avoided, we utilize the latest technology to assist our patients in a rapid and thorough recovery. From Physical Therapy, Dry Needling, and Laser therapy to PRP, bone marrow aspirate concentration containing stem cells, and more. Our number one priority is providing the treatments and solutions that are best for each individual patient.
Here’s to your health and longevity!
Dr. Ethan Kellum M.D.
Nashville Regenerative Orthopedics