Wednesday, April 17, 2024

Full-thickness Rotator Cuff Tear No Surgery

Do Rotator Cuff Tears Affect Both Shoulders

Treating Rotator Cuff Tears Without Surgery| Episode 52

Tears tend to occur on your dominant side, but can be on either side. Having a tear in one shoulder increases the likelihood of a tear in the opposite shoulder. You might not have shoulder pain on the opposite side, but tests may indicate a tear. The opposite may also be true: you may have a tear but have no pain or symptoms.

Research: Prolotherapy Effective In Helping Patients After Failed Rotator Cuff Surgery

Many people do well with rotator cuff surgery, these are typically not the people we see. We see the people who did not do well after the rotator cuff surgery. In many instances, we have been able to help these patients with pain and function. Doctors in Turkey have also seen the positive results of Prolotherapy treatments in patients following a failed rotator cuff surgery. In a study from February 2019, surgeons, sports specialists, and military doctors combined their research efforts to suggest the effectiveness of Prolotherapy injections in the treatment of failed rotator cuff repair surgery. The researchers concluded in their research:

Our study results show that prolotherapy is effective in the treatment of patients with failed rotator cuff repair surgery with significant improvements in shoulder function and pain relief.

Rotator Cuff Tears And Muscle Atrophy

This phenomenon can occur and involves the rotator cuff muscles shrinking and being replaced by fat. While there was a slight trend in that direction, no patient had serious fatty atrophy at follow-up. In addition, this study is consistent with another study that shows that the size of a rotator cuff tear is more likely than not to stay stable .

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How Do I Know If The Tendon Repair Has Torn Again

It is not easy to tell if the rotator cuff tendon repair has failed or not. The symptoms of pain or loss of strength are common after rotator cuff surgery while the tendons are healing, and minor setback are to be expected. We do not recommend a magnetic resonance scan or other studies when these setbacks occur for several reasons. The first reason is that magnetic resonance imaging after a surgical repair of the rotator cuff does not have the same accuracy in determining whether tendons are torn. If an MRI is performed, we recommend that it be performed with dye in the affected shoulder with a needle under x-ray or CAT scan guidance by a radiologist. This test is called an arthrogram-MRI and may be positive if the tendon has not had enough time to heal or if parts of the tendon have not healed to bone. As a result, within three months after a rotator cuff repair, it is common for the dye to leak through the tendon since it has not completely healed. After this period of time, the degree of tear in the tendons can be determined best with this study.

Why Surgery Isn’t Always Needed For Rotator Cuff Tears

Left Full Thickness Rotator Cuff Tear

Surgery is a common treatment for a rotator cuff tear, but it is not often the case that a rotator cuff tear requires surgery. The truth is that most people will eventually develop tears of their rotator cuff.

As people age, rotator cuff tears become increasingly common, even in people who never have symptoms of shoulder pain. Just as hair turns grey and skin wrinkles, as people get older, the rotator cuffs often develop wear and tear.

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How Long Does It Take To Recover From Rotator Cuff Surgery

It takes six to eight weeks for the tendon to heal to the bone. Complete recovery time varies by size of the tear. For a small tears, full recovery time is about four months, for large tears, six months. For severe, massive tears, a complete recovery can take anywhere from 6 to 12 months.

Patients can often return to most activities after about 12 weeks after surgery, but participation in vigorous sports may be restricted for four to six months. The goal is to achieve full range of motion and full strength.

Why Is My Rotator Cuff Not Healing

Why doesn’t the rotator cuff always heal? After the rotator cuff is attached to the bone it will require a lot of time to heal. Sometimes the reason why the rotator cuff doesn’t heal and tears again is that you may have become too active too quickly. This is a less common reason for failure of rotator cuff surgery.

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How To Prepare For Rotator Cuff Surgery

Rotator cuff surgery is considered for healthy and motivated individuals in whom rotator cuff tears interferes with shoulder function.

Successful rotator cuff surgery depends on a partnership between the patient and the experienced shoulder surgeon. The patient’s motivation and dedication are important elements of the partnership.

Patients should optimize their health so that they will be in the best possible condition for this procedure. Smoking should be stopped a month before surgery and not resumed for at least three months afterwards–ideally never. This is because smoking interferes with the healing of the rotator cuff repair and the strength of the cuff tendon. Any heart, lung, kidney, bladder, tooth, or gum problems should be managed before surgery. Any infection may be a reason to delay the operation.

The patient’s shoulder surgeon needs to be aware of all health issues including allergies and non-prescription and prescription medications being taken. Some of these may need to be modified or stopped. For instance aspirin and anti-inflammatory medication may affect the way the blood clots.

Recovery Time For Rotator Cuff Injuries Without Surgery

7 Weeks Post Op shoulder rotator cuff surgery recovery. Supraspinatus full thickness tear (Week 7)

Full recovery through rehabilitation alone will take 3 to 6 months. Improvement tends to be quicker since you wouldnt be compromising any graft or repair.

The goal of physical therapy is to correct modifiable impairments like weakness and tightness. Through this, you can relieve pain and dysfunction.

Fortunately, the success rate of rehabilitation as the main treatment is 80%. This is what should be done to heal your rotator cuff naturally:

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How Do You Treat A Supraspinatus Tendon Tear

A supraspinatus tear can be treated with medication, physical therapy, steroid injections, or surgery:

  • medication may include pain-relief and anti-inflammatory drugs to reduce swelling in the shoulder.
  • physical therapy involves advice on exercises to carry out which restore flexibility and strength to your shoulder.
  • What Are The Specific Types Of Rotator Cuff Tears

    There are small tears that we call high-grade tendinitis, which typically lead to shoulder impingement or subacromial impingement and bursitis. These are the small tears that are created from the shoulder ball impinging the rotator cuff on the clavicle or AC joint.

    The next type of tears or partial tears, almost like a frayed rope. These are still attached to bone and are very responsive to physical therapy and injections.

    The next type of tear is a full-thickness retracted tear where it is ripped off bone. This is typically presents with weakness of the shoulder and decreased range of motion.

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    It Is Difficult To Get Stem Cells To Fix The Extensive Damage Of Surgery At The Time Of The Surgery

    University and medical researchers in Mexico published a comprehensive review of the use of stem cells in the healing of various degenerative injuries of the joints and spine. When they got to rotator cuff tears this is what they said in the journal Stem Cell International:

    • Between 30% and 94% of rotator cuff repairs result in failure, perhaps because the highly specialized fibrocartilaginous transition area connecting the rotator cuff and the bone fails to regenerate following repair. The tissue that is formed after the surgery is fibrovascular scar tissue, and its mechanical properties are relatively poor.
    • Simply the surgery caused the formation of scar tissue where elastic and flexible tissue that allows the shoulder its vast range of motion should be.
  • To answer to the high rate of surgical failure? new materials and surgical techniques have been refined in an effort to augment the strength of the regenerated tissue and replicate the anatomical footprint of the rotator cuff. Stem cells.
  • In their research, the Mexican team found promising results but limited results in that stem cells could affect significant changes in the formation of scar tissue during the surgery. In fact, they cite the work of Dr. João L. Ellera Gomes in Brazil who published that dipping surgical suture in stem cells obtained from a bone marrow aspirate from the iliac crest and going through the bone to hold everything together , was effective for 12 out of 12 months at 12 months follow up.

    Can We Help You Get Back To Work Sport Or Simply A Better Quality Of Life

    Rotator Cuff Tear Wall Poster

    A patient came into our clinic. She had been recommended for rotator cuff surgery. Her story goes something like this:

    She woke up one morning with significant shoulder pain. The pain started as a small, nagging twinge but worsened over the following months. When the pain became chronic, she decided to consult with an orthopedic physician. According to x-ray and MRI results, she was dealing with an impingement as well as a rotator cuff tear. The orthopedic performed a cortisone injection which temporarily relieves her shoulder pain.

    The patient was a golfer and she could still play golf on a regular basis, despite a painful swing. The patient also kept in shape by lifting weights. An activity she was frightened to continue for fear of worsening her injury. Eventually, the shoulder pain caused significant decreases in her quality of life. She could not perform basic tasks such as getting dressed without pain and the pain would eventually interrupt her sleep.

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    Can You Tell If You Have A Full Thickness Rotator Cuff Tear

    After a significant trauma such as a fall or a car accident, your rotator cuff tendon can literally pull right off the bone. We call that an acute, traumatic full-thickness rotator cuff tear. On the other hand, I see many patients in the office who do not recall any significant injury, but their exam and MRI demonstrate that they have a full thickness tear why is that? The risk of developing a rotator cuff tear increases with age because our tendons begin to gradually wear, lose its blood supply and its resilience. In that situation, even routine daily activities like gardening or working around the house increase the potential for wear, degeneration, and tearing.

    Whether your tear is chronic, attritional or acute and traumatic is a VERY important element of the Treatment decisions are based not only on the type of tear you have, but whether or not other treatments have failed, and how poor your quality of life is.

    Rotator cuff tears, whether acute or chronic can cause severe pain. Many of you report temporary relief using:

    What Is The Success Rate For Rotator Cuff Surgery

    Rotator cuff surgery has more than a 95% success rate for small tears. For two tendon tears, the success rate is still greater than 70%. Untreated tears tend to get bigger, so it is best to repair tears while they are small.

    However, even those patients with very large tendon tears may benefit from surgery. In some cases, we can use a technique called margin conversions. This involves covering the humeral head with grafted tissue to hold the tendon in place in the joint. When the tendon tissue is insufficient for direct repair, we place a patch of donated tissue in the area. When these tissue grafts are required, shoulder surgeons usually perform a mini-open repair, rather than an arthroscopic repair.

    Arthroscopic images provided courtesy of .

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    Will A Full Thickness Rotator Cuff Tear Always Require Surgery

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    Are There Any Medications That I Should Not Take During My Recovery/rehabilitation

    5 weeks Post Op Rotator Cuff Surgery. Full thickness tear Supraspinatus. Recovery update

    You can take Tylenol or any of the pain medications Dr. Jurek prescribes. Also, frequent icing of your shoulder will assist with pain management. Some research points to the possibility that non-steroidal anti-inflammatories may hinder tendon healing. Hence, it is best to take these medications sparingly while your rotator cuff repair heals.

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    Why Rotator Cuff Tendons Get Tears

    It is not known why rotator cuff tendons develop tears, but its associated with aging. By the time someone is 60 years old, there is a good chance they have some partial tears or complete tears of the rotator cuff.

    One common theory suggested that the tendon hits against bone spurs, but that is now considered an unlikely cause. Regardless of how these changes occur, tears happen to people from all walks of life and all occupations. As a result, the consensus is that changes in the rotator cuff with age are part of becoming more mature.

    Occasionally, patients younger than 35 get partial tears of the rotator cuff. These tears may be associated with an injury. Partial rotator cuff tears are common in people who are overhead athletes , such as pitchers in baseball. Partial rotator cuff tears in competitive athletes are treated the same way as partial tears in aging adults.

    What Causes A Rotator Cuff Tear

    An accident, such as a fall, can cause a broken collarbone or dislocated shoulder that tears the rotator cuff.

    More commonly, rotator cuff tears occur over time as the tendon wears down with age and use . People over 40 are most at risk.

    Causes of degenerative tears include:

    • Bone spurs: Bony growths can form on the top of the shoulder bone. These bone spurs rub against the tendon when you lift your arm. This shoulder impingement creates friction between the bone and tendon. Eventually, a partial or complete tear may occur.
    • Blood flow to the rotator cuff decreases as you get older. Your muscles and tendons need a healthy blood supply to repair themselves. If blood doesnt nourish the tendons, they can tear.
    • Overuse: Repetitive shoulder movements during sports or on the job can stress muscles and tendons, causing a tear.

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    What Are The Chances A Tear Will Heal With Surgery

    There have been many studies that tell us approximate odds of tendons healing with surgery depend upon the size of the tendon . It has been demonstrated that small full thickness tears the size of a fingernail heal in a majority of cases, but approximately 5% will not heal for the reasons mentioned in the discussion above. For full thickness tears that are moderate size , the re-tear rate is around 20% . For large tears , the re-tear rate is approximately 27% . For massive tears , the re-tear rate is anywhere from 50 to 90% . The reason for this high failure rate with large to massive tears is because there is a hole too large to be filled by stretching the remaining tendon, and the edges of the tendon will not hold the stitches used in the repair of the tendons.

    Why I Was Able To Live With A Torn Rotator Cuff Without Surgery

    Acute rotator cuff tears

    I was curious to know why some friends who had the same problem complained about excruciating pain, or lost their ability to use their shoulder.

    My doctor explained that my muscles were well balanced and compensated for the torn tendons in my case. That came from a lifetime of proper exercise. You may laugh, but since high school, I kept doing those push-ups we had to do in gym class. Maybe that made the difference.

    Nevertheless, I still hurt myself. How? I dont know for sure. I have always done extreme things that maybe I should have stopped doing as I got older. I like to do carpentry around the house, and I sometimes move heavy objects, even lifting them above my head to place on racks high up.That must be it!Remember, the surgery might not work that well in my case since I waited so long. In addition to that, its not recommended when one still has functionality anyway, as I do.

    I discussed this with my new orthopedist, who I went to for a second opinion. I asked her what I could do to get through the rest of my life if I dont have surgery. Her answer was, Avoid lifting things above your shoulders.

    I asked why. She explained that we use different muscles when we lift things only up to shoulder level, but when we lift things higher than our shoulders, we’re putting the stress on our rotator cuff.

    Wow! That was an enlightening lesson. They should teach us those things in high school to take with us throughout life!

    Lessons They Should Teach in School

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    Pain Management During And After Rotator Cuff Surgery

    Rotator cuff surgery is a major surgical procedure that involves cutting of skin, release of scar tissue, and suturing of tendons and bone. The pain from this surgery is managed by the anesthetic and by pain medications. Immediately after surgery strong medications are often given by injection. Within a day or so oral pain medications are usually sufficient.

    Initially pain medication is administered usually intravenously or intramuscularly. Sometimes patient controlled analgesia is used to allow the patient to administer the medication as needed. Hydrocodone or Tylenol with codeine are taken by mouth. Intravenous pain medications are usually needed only for the first day or two after the procedure. Oral pain medications are usually needed only for the first two weeks after the procedure.

    Pain medications can be very powerful and effective. Their proper use lies in the balancing of their pain relieving effect and their other less desirable effects. Good pain control is an important part of the postoperative management.

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