Have you been told that invasive surgery is your only option to treat your shoulder pain? In this article we look at the pros and cons of surgery and what the evidence behind shoulder surgery truly is.
Given that there is an estimated 40,000 shoulder rotator cuff tear repair surgeries conducted annually in the U.S. one might assume that there is substantial medical proof backing the effectiveness of such a treatment. The Agency for Healthcare Research and Quality recently published a review after going over an excess of 150 research papers concluding that hard evidence supporting the claim that rotator cuff surgery was beneficial to patients as opposed to no surgery was near non-existent.
This is a bit shocking especially since we seem to be rather trigger-happy when it comes to providing and suggesting surgery without actually knowing if or not it is actually even effective. Like most other disciplines and professions, fast spreading trends can take root without much evidence to support the treatment. Here, the notion was that sewing a torn rotator cuff back together might be beneficial. Though this may be helpful for certain patients, it also means prolonged immobilization as the area to be healed must first be surgically softened. Such prolonged inactivity can also lead to atrophy or weakness post healing in the rotator cuff muscles and tendons.
About 10% of patients that have a shoulder surgery will have a significant complication. These complications can include shoulder stiffness (frozen shoulder), inadequate healing, infection, reflex sympathetic dystrophy, deep venous thrombosis (blood clot), and death. A frequent complication is to re-tear the shoulder rotator cuff tear once it’s been surgically repaired. Older patients are the most likely to re-tear their rotator cuffs despite surgery. In one study, for patients over 65 with full thickness tears had a re-tear 42% of the time after surgery. In another study larger rotator cuff tears retore 57% of the time over the course of 10 years.
The type of shoulder surgery a patient has might affect the re-tear rate as well. For example, in one study, open repair (where the shoulder is opened with a more traditional large incision) had a 39% re-tear rate, whereas arthroscopic repair had lower rates (16-25%). However, another study showed just the opposite, that re-tear rates in large tears happened more with arthroscopic surgery and less with open surgery.
How long can someone wait before considering surgery?
A study in 2011 looked at this very question, what was the optimal time to consider surgery for a rotator cuff tear. This study looked at people with a painful tear due to trauma, with weakness in the shoulder, and couldn’t fully lift the shoulder to the side or over their head. The study concluded that surgical rotator cuff tear outcome wasn’t compromised (regardless of the rotator cuff tear size) up to four months after injury. Most tears could also wait longer, but patients with massive rotator cuff tears who waited longer than 4 months had the worst outcome. This means that there is no harm to trying less invasive regenerative options such as prp or stem cell injections during the first 4 months.
What happens to a rotator cuff tear if left untreated for too long?
The muscle can begin to suffer from fat atrophy (the muscle gets weaker and replaced by fat). If fat atrophy develops it means that there’s less muscle, which means the rotator cuff muscles can’t stabilize and protect the shoulder joint. Although it would make sense that repairing the tear surgically would help regain the lost muscle, according to the evidence this is wrong. What’s worse is that patients with more fat atrophy had a higher rate of tear recurrence.
Most patients believe surgery is the quick fix, like taking your car into the mechanic to replace a worn-out part and coming out with the shoulder performing like new. Unfortunately this is not the case, there is an interesting study presented at the Orthopedic Research Society on how shoulder range of motion and stability aren’t restored fully by rotator cuff surgery. We commonly hear patients complain of less function after surgery than they had before surgery, so this study is helpful to see why this happens. The researchers looked at the patient’s shoulder that was operated with rotator cuff surgery vs. the opposite shoulder without the surgery. The shoulder movement was analyzed at 3, 12, and 24 months after surgery. They concluded that shoulder strength and joint stability as well as range of motion wasn’t restored.
So where do you go from here? Go in for surgery or reconsider? For our patients with larger tears but possessing healthy tissue who are active and require rotator cuff muscles in working order, we feel surgery might just be their best option. On the other hand, if the cuff tear is partial or a full thickness rotator cuff tear without retraction, it might make more sense to look into non-surgical injection based repair rotator cuff strategies as opposed to surgery. Such injections allow for increased activity during and after treatment and recovery which might even serve to help strengthen the shoulder rotator cuff repair when compared to more invasive methods!
So before you consider a surgery that can never be undone you may want to consider non-surgical regenerative injections such as prp or stem cell injections that uses your own cells to repair the damage, help alleviate shoulder pain and restore joint damage. Downtime is less than half that of surgery, with little to no need for pain medications, lengthy rehab or time off of work.
*DISCLAIMER: Like all medical procedures, Well Life Regenerative Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.