What Are Your Options When Your Rotator Cuff Can't Be Repaired?
Shoulder pain, secondary to a rotator cuff tear, is one of the most common reasons for a visit to your doctor or orthopedic surgeon. The rotator cuff is a group of muscles that are deep in the shoulder surrounding the ball and socket joint and work to allow you to elevate your arm. People often note discomfort and difficulty lifting their arm when there is a problem.
You don’t have to be a baseball player to get a rotator cuff tear.
Like all the tissues in the body, the cuff ages and degenerates. As a person ages, a tear can develop that slowly progresses over time and presents with increased pain and difficulty using the arm. A traumatic event may also accelerate or exacerbate the injury.
Treatment for rotator cuff tears is evolving. Nonoperative care, which includes medication, physical therapy and possibly a steroid/cortisone injection, is often tried first for degenerative tears. Surgical repair is often recommended early for traumatic tears or in active patients with good quality tissue.
Unfortunately, not everyone with a rotator cuff tear is a candidate for an anatomic surgical repair. Sometimes the tears have progressed and tissues degenerate/atrophy and are not repairable. Fortunately, there are some very promising solutions
REVERSE SHOULDER REPLACEMENT
In 2004, the FDA approved a novel reverse shoulder replacement for use in the United States. Since its introduction, it has become more common than the original anatomic prosthesis. It is designed to work without a functional rotator cuff. Recovery after surgery is usually quick with predictable pain relief. Because of concerns with longevity, it is usually reserved for older patients with large irreparable rotator cuffs with arthritis. It’s considered a big surgery with potentially larger complications. Fortunately, as our experience with this procedure evolves, complications are becoming less frequent.
SUPERIOR CAPSULAR RECONSTRUCTION
This is a technique that was developed in Japan and utilizes a tissue graft to replace the lining of the rotator cuff (superior capsule) that provides stability to the shoulder. Though it doesn’t replace the active muscle component of the cuff, it does compensate for some of the rotator cuff function. A big advantage of this surgery is the ability for it to be performed using minimally invasive arthroscopic techniques. The recovery period is typically more extensive with a greater emphasis on physical therapy. Results so far have been very promising and performed with greater frequency in the United States.
LARGE ROTATOR CUFF TEAR
AFTER SUPERIOR CAPSULAR RECONSTRUCTION
Muscles and tendons around the shoulder that are in good condition can be moved or transferred to compensate for a large irreparable rotator cuff. As you might expect, this is a large involved procedure that sacrifices some of the original function of the transferred muscle. There is considerable postoperative physical therapy as the original muscle must be “retrained” to function in its new role. Usually, this procedure is reserved for younger patients with large irreparable tears and significant functional deficits.
ARTHROSCOPIC DEBRIDEMENT/PARTIAL REPAIRS
In some situations, limited arthroscopic procedures may be of value when surgery is considered. This can include removing inflamed and/or diseased tissue (debridement) or even attempting to repair some of the better-quality rotator cuff tissue (partial repair).
ON THE HORIZON
There are always exciting new technologies and techniques being developed in the world of shoulder surgery. One of the latest, currently being studied and not yet approved, is a minimally invasive biodegradable balloon that is inserted into the shoulder with a needle-like device and inflated. It cushions the interface between the humerus (ball) and the acromion (undersurface of the tip of the shoulder) and may improve shoulder stability. Currently, this technique is being used outside the United States.
Biologic agents, such as stem cells, are frequent sources of buzz and discussion in the orthopedic world. Regenerative medicine is a booming field that appears to hold a lot of promise for many musculoskeletal conditions. Currently, these treatments are considered experimental and typically are not covered by insurance carriers.