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When Not to Have Rotator Cuff Surgery

By November 4, 2022No Comments

Rotator cuff tear is a common condition that occurs as people age. It affects an individual’s shoulders, and most of the time, the symptoms may not appear in the beginning stages. The pain is typically mild and can be relieved without surgical treatment. 

The decision to go for surgery depends on the type of injury and the patient’s age. Many rotator cuff injuries can be healed with simple or orthobiologic treatments.

What Is a Rotator Cuff?

A rotator cuff comprises four tendons and muscles surrounding your shoulder’s ball and socket joint. These include the supraspinatus, infraspinatus, subscapularis, and teres minor. The rotator cuff keeps your shoulder joint stabilized and functional. 

It helps you reach outward, overhead, and in any direction you want. However, over time, the tendons in the rotator cuff become susceptible to degeneration, tendonitis, usual wear and tear, and acute inflammation. The first symptoms are shoulder pain, muscle weakness, and joint movement. 

Rotator cuff tears are pretty common. People with diabetes, elevated blood pressure, increased cholesterol, impingement, diabetes, and smoking habits are at a higher risk for rotator cuff tears. Moreover, those who do extensive shoulder exercises may also have more rotator cuff tear risks.

The doctor will use imaging tests (X-ray, MRI, and ultrasound) to examine your shoulder and determine the amount of damage done.

What Causes Rotator Cuff Tears?

Several factors can result in rotator cuff tears; some are natural, while others are self-caused. Here are the three main causes of these tears:

Aging

As we age, our rotator cuff tendons naturally become weak. This increases the chances of several injuries. That’s mainly because the stem cells in our tendons decline over time. A few stem cells mean more chances of having tendon injuries, including tears. 

Trauma

Rotator cuff tears can also occur due to self-caused factors, such as car accidents, sports injuries, or carelessness when lifting heavy things. All these things can cause trauma to your rotator cuff, resulting in tears. 

Overuse

Rotator cuff tears may not occur if you avoid overusing the muscles. However, athletes, workers, and weight lifters are more likely to have this injury since they constantly use the rotator cuff.

Types of Rotator Cuff Tears

Types of Rotator Cuff Tears

Rotator cuff tears differ depending on their location and intensity. Here are the three most common types of rotator cuff tears you must know:

Partial Thickness Tear (PTT)

The partial thickness tear can occur at three locations in your rotator cuff. First, when a part of the tendon is torn near the top, the tear is known as the bursal-sided tear. The tear can also be present at the tendon’s bottom. In that case, it is called an articular-sided tear. 

Finally, if the tear is located on the tendon’s inside area, it is known as an interstitial or intrasubstance tear.

Complete Non-Retracted Tear

A complete non-retracted tear is when the tear extends through the tendon but doesn’t break it down entirely. Instead, the tendon remains together with the help of tiny remaining fibers. 

Complete Retracted Tear

It is when the tear extends through the entire tendon and breaks it apart. As a result, the rotator cuff has two broken tendons pulled apart like a rubber band. Many people also call a complete retracted tear a massive rotator cuff tear. 

What Is Rotator Cuff Surgery? When Not To Have It?

Rotator cuff surgery involves cutting down your damaged rotator cuff and re-attaching the tendon to the humerus (upper arm bone). The surgeon drills an anchor into the bone, which attaches the tendon firmly to the humerus. Shoulder arthroscopy is the most common surgery for rotator cuff tears.

However, the treatment depends on the injury type and the patient’s age. Most of the time, people don’t show or feel any symptoms of rotator cuff tears. In these cases, there is no need to have rotator cuff surgery

Also, if you have a complete non-retracted tear or partial thickness tear, there is no need for surgical treatments. Studies have shown that opting for surgeries for these two types of tears give similar results as physical therapy. In fact, surgical treatments in these cases fail in 6 out of 10 patients, as they could result in re-tearing the tendon.

Non-Surgical Treatment Options for Rotator Cuff Tears

Your healthcare provider will recommend you any of these three effective non-surgical treatments for rotator cuff tears:

These treatment options will reduce pain and enhance your shoulder muscle strength. But if these methods don’t work, you can opt for orthobiologic methods. These methods are less invasive and painful than surgeries and give effective results. 

At CELLAXYS, we perform two main orthobiologic treatments for rotator cuff tears: cell-based and platelet-rich plasma (PRP) therapy. Depending on your shoulder’s condition, your doctor may recommend one of the two types of treatment options.

Platelet-Rich Plasma (PRP) Therapy 

PRP is a popular treatment for many orthopedic, spine, and sports injuries. It involves taking the patient’s blood sample, isolating platelets from the plasma, and reinjecting them into the patient’s injury site. Platelets serve as the first line of defense in any kind of injury. 

These components perform three main functions. They release 10 Growth Factors for tissue development, attract healing cells from the blood, and produce a web-like scaffolding called fibrin to boost the growth of new cells. A higher number of platelets in the rotator cuff will speed up your healing process. 

Cell-Based Therapies

Also known as stem cell therapies, cell-based therapies use the patient’s own or “autologous” tissues. The process includes harvesting healthy cells from the patient’s adipose cells or bone marrow, processing them, and reinjecting them into the patient’s injury site. 

Since the process uses the patient’s own cells and tissues, the acceptance rate is quite high. There are two options available in cell-based therapies, including:

  • Minimally Manipulated Adipose Tissue Transplant (MMAT). When the cells are taken from the patient’s adipose (fat) tissue, the process is called MMAT. The best part about this process is that it can be performed at multiple locations in the same procedure. 

Both PRP and cell-based therapies are outpatient procedures, which means you can go home after the process completes. Cell-based therapies take about 1.5 to 2 hours to complete, while PRP is completed within 45 minutes. The doctor uses live X-rays or Ultrasounds to determine the exact location of the injury.

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni

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