Ask a Vail Sports Doc column: How can I treat my rotator cuff tear?
Q: Is there anything new in the treatment of large rotator cuff tears? I just moved here, but my prior orthopedic doctor told me that my rotator cuff tear was too big to repair and it causes me a lot of pain.
A: A rotator cuff tendon can either partially or fully tear off of its bony attachment. The incidence of rotator cuff tears increase with age.
Patients with rotator cuff tendon tears mainly complain of pain. The pain is worse when the arm is in certain positions, such as when reaching overhead, putting on a coat or reaching for a seatbelt. Patients typically complain of pain at night that wakes them from sleep, and this is what commonly brings people into the office to see me. Unfortunately, most rotator cuff tendon tears do not heal themselves. Instead, these tears usually worsen, with the tear getting larger and more retracted.
As for diagnostic tests, I obtain a shoulder X-ray to rule out arthritis or calcium deposits in the rotator cuff tendons. If there is concern for a rotator cuff tear, an MRI is ordered. An MRI nicely shows if the rotator cuff tendons are just inflamed or if they are torn.
As for the treatment of rotator cuff tears, I typically recommend nonsurgical management of smaller, partial thickness tears. I prescribe physical therapy to reverse any stiffness that may have developed in the shoulder, as well as to strengthen all the muscles around the shoulder and scapula. I also prescribe short courses of an anti-inflammatory medication or perform a single subacromial steroid injection, which is helpful in calming down the inflammation and pain so patients can participate in physical therapy and sleep better.
If a patient is active and otherwise healthy and has a full thickness tear of one or more of his or her rotator cuff tendons, I recommend surgery. Small suture anchors are inserted into the bone, and then the strong sutures that are attached to these anchors in the bone are passed up through the torn and retracted tendons and the tendon is sewn back to the debrided bone so it can heal itself to the bone.
Up until several years ago, there was not a good option to treat very large, severely retracted rotator cuff tears. Patients would get occasional injections into the shoulder to help manage the pain, and they could do basic therapy exercises that would help somewhat, but otherwise, patients would basically have to live with the pain.
As for surgery, all that was available was a salvage type of shoulder replacement called a reverse total shoulder arthroplasty. However, a Japanese surgeon recently pioneered a technique called superior capsular reconstruction. In this, an acellular dermal extracellular matrix (similar to a donor tendon) is used to bridge the gap when a rotator cuff tendon is too far retracted to stretch out and reattach. This dermal allograft is sewn to the top of the socket and the top of the humerus, which significantly helps decrease one’s pain and improve one’s shoulder range of motion and function.
Results of superior capsular reconstruction have been very promising for massive retracted rotator cuff tears, offering new hope for patients with this diagnosis.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team and president of Vail-Summit Orthopaedics. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at http://www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.
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