Current treatments may not be adequate for irreparable tears
Conservative care is offered to patients before surgery. Patients with moderate pain and reasonable functioning of the arm are generally first treated with pain medications.
- Medications – Drugs, which are not intended to treat the injury but rather to alleviate pain, include anti-inflammatory medications. A local anaesthetic or steroid injection can be used to block the pain after which anti-inflammatory treatment can commence.
- Physical therapy – Treatment generally begins with preliminary rest and restriction from activities. A passive range-of-motion program is started to help prevent stiffness and maintain joint use.
- Alternative Treatments – Some patients find that treatments such as shiatsu and acupuncture are helpful, despite the fact that there is no scientific evidence that they are effective.
Patients who do not respond to or are unsatisfied with conservative treatment should seek operative management.
If conservative treatments produce poor results, surgery is considered to repair the torn tendons. There are several different surgical options for rotator cuff repair. Massive tears are usually treated via an open procedure, despite the fact that arthroscopic techniques may be successful in repairing even the larger tears and involve a shorter recovery period compared with open surgery. In more extreme cases and when all else has failed, a procedure called shoulder reversal may be performed.
A complete full-thickness rotator cuff tear repair involves connecting the torn rotator cuff by suturing the tendon back together with the bone (the ball of the humerus). This is usually undertaken by placing an anchor in the bone at the attachment site and suturing the torn tendon end back down to the bone from which it originally tore away. During surgery the physician may conduct two additional procedures: debridement, which removes soft tissue or bone fragments that may be connected to the bone; and acromioplasty, which shaves some of the bone underneath the shoulder blade to give the tendon additional movement space.
If the above surgery cannot be performed, and your rotator cuff is deemed irreparable, your doctor may recommend a procedure called reverse total shoulder arthroplasty. During surgery, the orientation of the shoulder is altered. The normal socket is replaced with a metal ball, and the normal ball (humeral head) is replaced with a humeral stem with a socket. Shoulder mechanics are changed so that some of the muscles gain tension and your ability to raise the arm is restored while lessening pain.
There are significant limitations to these approaches:
- Surgery – Major surgery in itself requires hospitalization and a lengthy rehabilitation.
- Extremely long recovery – Recovery can take as long as 3-6 months. A sling is worn for up to 6 weeks following the operation.
- Pain – Post-surgical pain is high. Pain is present for many months during the recuperation period.
- Very high recurrence – The repaired tendon tends to tear away from the anchor, in most cases requiring reintervention.
The OrthoSpace InSpace™ system is a viable alternative to major surgery, predominantly in patients with difficult-to-treat rotator cuff tears (irreparable), and an alternative to shoulder reversal. The procedure is minimally invasive and performed in an outpatient setting. Read more about InSpace™ solution here.