Great Alternatives To Rotator Cuff Surgery!

The marriage of medicine and technology has been a fruitful one. We now have many beneficial technological tools to aid us in diagnosing and understanding diseases. Unfortunately, too much dependence on technology alone can lead to misdiagnosis and mismanagement. An example of this is the over-reliance on Magnetic Resonance Imaging, (MRI), to make surgical decisions in rotator cuff tears.

The rotator cuff is a group of 4 muscles which stabilize the shoulder. With injury, one or more of the group can be partially or completely torn. Yet, this often does not require surgical repair to achieve healing and return to full function. Consider this: a study published in the Journal of Bone and Joint Surgery in 1995 showed that 34% of people with normal shoulder function have a torn rotator cuff visible on MRI! Of these, about half were complete (full thickness) tears! The percentage of men over 60 who have fully functional shoulders, but an evident rotator cuff tear on MRI, is 50%!

The article concludes by pointing out the potential hazards of the use of MRI scans alone as a basis for rotator cuff surgery, and argues for an accompanying thorough physical examination.

Once diagnosed with a rotator cuff tear, many people understandably want a surgical fix, thinking it will solve the problem quickly and permanently. However, the results of rotator cuff surgery are not as predictable as many, including patients, their families, athletic trainers, coaches, and even many physicians would like to think.

Over the years, rotator cuff surgery techniques have improved dramatically, yet re-tear rate remains above 20%, and increases with tear severity.

Tear recurrence can be related to various factors such as:

• Inadequate strength of the initial repair construct

• Biological failure to heal despite strong initial fixation (hardware and suture)

• Inappropriate postoperative rehabilitation causing structural failure of the repair

  
  

Yet there is great news here! Many rotator cuff tears can be successfully repaired, and shoulder function restored, using non-surgical approaches. In fact, for most patients with a rotator cuff tear, conservative management with exercise, Osteopathic manipulation, acupuncture, or prolotherapy is successful.