Our Philosophy on Rotator Cuff Treatment Options
The treatment of rotator cuff “tears” has a whole spectrum of treatment options and tear types. In my practice, SURGERY IS THE LAST RESORT.
First, understand that some degree of “abnormal” rotator cuff problems are present in the majority of people and, in most, are totally asymptomatic. In some studies, it has been found that the “chances” of having an abnormal rotator cuff read on an MRI, be it a partial tear or a full tear, is about 1% per year of age. For example, a 50- year old has at least a 50% chance of showing an “abnormal” cuff in an MRI. True, it just started hurting, or you just slept on it wrong, or you just fell, but this does not mean you just tore it; You may have just made it symptomatic for the first time.
The treatment of tears is controversial. In some studies, especially in patients 55 and older, the operative results have just as many successes and failures as the non-operative patients at 2 years out. In at least ½ of the studies following rotator cuff surgery, about ½ never “took” or easily re-tore. HALF! In some recent studies, the majority of “partial tears” went on to heal whereas about 15% escalated to a complete tear. This is just from a normal lifestyle. Keep in mind there are plenty of small sample studies that say other words but many are in agreement with what I just pointed out.
Let’s talk about MRIs, which I don’t prescribe very often. Many MRIs, like in the knees, have false negatives (they say there is no tear when there actually is one), and false positives, (that is, they say there is a tear when there really isn’t). They are expensive and really hit YOUR DEDUCTIBLE hard. My treatment, (AND ALL CONSERVATIVE TREATMENT) initially, is about the same: Injection, anti-inflammatories, and immediate exercises. IF one gets a successful result from the injection (that is pain relief for a couple weeks) and the pain or weakness returns, THEN surgery will be indicated IF the patient wishes to go that route. Perhaps then, an MRI is recommended.
In my opinion, there are two main reasons to undergo surgery for Rotator Cuff issues.
- Pain, that fails conservative care, that IS UNACCEPTABLE TO THE PATIENT
- Weakness, that fails conservative care, that IS UNACCEPTABLE TO THE PATIENT
Then, the surgery would entail arthroscopic procedures to be discussed with the patient and really depends on just how much downtime the patient wants to undergo after the procedure. MANY OPTIONS EXIST as one procedure does not fit all.
If you think you’ve torn your rotator cuff, then it’s important to talk to a physician and develop a treatment plan that suits your needs. Give us a call today at (210) 696-9000 to schedule a consultation with one of our physicians.