Rotator Cuff Injury: Symptoms, Exercises & Repair by Dr Cherif Tadros
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Rotator Cuff Tear: When Shall the Patient Get a Surgery?

Studies on cadavers revealed that 50% of the population had a rotator cuff tear. Obviously, chances increased as the subject was older. Some recent studies by MRI showed asymptomatic tears among 24% of the sampled patients, 38% among patients aged 70 and up.

A high percentage of patients experimenting neither pain nor restriction is good news as they do not need to be operated. However, remember  that, as the tear grows in size, discomfort may appear. Also, as the population is aging, orthopedics expect to diagnose more rotator cuff tear. Nowadays, elder people are more active, practice more sports and expect more performance from their body. That is why patients suffering from a tear in the rotator cuff will be more intolerant to limitations on their day-to-day activities. Symptoms experimented include stiffness while throwing a ball, pain when raising a weight greater than 4 kilos up to the shoulders and/or discomfort while sleeping.

Besides, a massive tear and chronic sore shoulder may turn into a severe wear-out of the articular cartilage between the humerus and the bone behind the infraspinatus, the  shoulder blade (aka scapula)(see http://rotator-cuff-by-dr-cherif-tadros.com/what-is-the-rotator-cuff/). This medical case may be complicated to treat.

Most specialists therefore suggest the rotator cuff repair, which average almost 85% satisfaction among treated patients. In other hand, the conservative treatment to rotator cuff tears can heal the pain and improve its function for half of the patients (see http://rotator-cuff-by-dr-cherif-tadros.com/rehab-exercises/). The surgeon will opt for the conservative treatment if the main complaint is soreness. If weakness is also a problem, the patient needs to go through surgery, so should chronic symptoms that last more than 6-12 months or a massive tear of more than 3cm long. (see http://rotator-cuff-by-dr-cherif-tadros.com/rotator-cuff-surgery/rotator-cuff-surgery/) Patients that go through the conservative treatment avoid absenteeism or eventual postoperative complications such as infection, permanent ankylosis or complications related to anesthesia. Overtime, persistent weakness, increased tear and reduced mobility is witnessed, the doctor will send his patient to me, the orthopedic surgeon.

Indeed, a surgical treatment is indicated to patients without improvement with the conservative treatment. unless the weakness is major, the tear is more than 3cm or a tear that results from an accident on a young patient, most surgeons will suggest to try the conservative treatment if the referrer did not.  Bear in mind that on an older patient (40 years old and older) dislocate his shoulder for a second time, a complete tear needs to be eliminated as opposed to a young patient for which case lambral tear or Bankart lesion would be the cause.

Although 80% to 95% of patients improved their conditions after the surgery, few factors decrease chances of success such as poor tissue, massive tears, poor postoperative training, older patients, CSST cases. Also, rotator cuff complications following a surgery may be nerve damage (1-2%, mostly to the axillary nerve), infection (1%), detached deltoid (less than 1% mostly on open surgery, not on mini-open or arthroscopy), ankylosis (less than 1%, which can be avoid by early rehabilitation exercises) or more often, another rotator cuff tear (6%).

A partial tear, as seen often on MRI, does not indicate that the patient needs to get the surgery. Acromioplasty  is recommended if the injury is very severe or when nonsurgical treatment has failed to improve shoulder strength and movement sufficiently after 6 months. (The conservative treatment involve taking non-steroidal anti-inflammatory drugs, going through physiotherapy, getting infiltration injections to heal the pain and changes in daily activities if possible).

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