ROTATOR CUFF – NEWS & TIPS
RC Surgery Failure Rate
Not only are rotator cuff repair surgeries often not necessary, as discussed in the article “When Not to Fix” below. Surgical repairs of large rotator cuff tears in older patients have a 94 % failure rate! Now Washington University orthopedic researchers and engineers are doing a $3.1 million study of the natural attachment of tendon to bone, hoping to engineer new tissues to enhance rotator cuff repair.
When Not to Fix
A lot of surgeries that are done for rotator cuff tears and other orthopedic conditions are not actually necessary, suggests Dr. Howard Luks, Associate Professor of Orthopedic Surgery at New York Medical College and Chief of Sports Medicine and Arthroscopy at Westchester Medical Center.
“Many patients are under the unfortunate impression that if something is torn it must be fixed,” according to Dr. Luks. “Nearly all patients who are informed that they have a torn meniscus or a torn rotator cuff will immediately conclude that they need surgery to repair the problem.”
So writes Dr. Howard Luks in a July 22, 2013 commentary on the Rheumatology Network, “When Not to Fix: Thoughts of an Orthopaedic Surgeon.”
However, writes Dr. Luks, “Patients who are informed fully about the various risks and benefits of surgical and nonsurgical measures generally tend to opt for less-invasive procedures.”
For example, according to Dr. Luks, “It has been estimated that anywhere from 15% to 20% of knee replacements and arthroscopy for various orthopedic conditions are unnecessary. I suspect that actually this number may be higher; however, the data is lacking.”
An example of Dr. Luks’ point, specifically for the question of rotator cuff surgery, can be seen below on this Web page under “Surgery Not Necessary?”
“One driving force that is emerging in our high-tech, low-touch approach to healthcare is our tendency to rely far too much on technology such as MRI findings, and too little on our physical exam findings and on the story our patient is telling us” write Dr. Luks.
“Are we treating these patients?” he asks. “Or are we treating their MRI findings?
The Right Exercise
Here’s an illustration of “the right exercise” for rotator cuffs. I have two bad rotator cuffs which gave me pain for years, made it hard to sleep at night and awkward to function during the day. Last year, I worked outdoors in the mountains from May to October, and at the end of that time, my cuff problems were gone. My work had involved constant use of the arms in going up steep hills and pulling through brush. Within a month or two of desk work back in the city, though, I started feeling them again and the pain was a problem through winter and spring. Then I noticed that after downhill or cross-country skiing, they felt better, only to revert when I did not ski. Then last week, I spent a week paddling whitewater canoe in North Carolina, and now, again, they feel better. What I need to do, what we all need to do, according to Dr. Nicholas DiNubile, is a better job of exercising the right muscles on a daily basis, and place less emphasis on exercising the so-called “mirror muscles” and working outside the “safe” range of motion.
So again, the key, as I read the advice of the experts, is the use of the right muscles in a safe range of motion, with a lot of pulling down and pulling back against force. These forces work the muscles known as “scapular stabilizers:” rhomboids, serratus anterior, trapezoid, levator scapulae. And others, such as the posterior deltoids. For more detail, see: Rotator Cuff Exercises.
Surgery Not Necessary?
So, this article from the Journal of Musculoskeletal Medicine article references a study indicating that three out of four (75% 117 patients studied) patients with massive rotator cuff tears were able to forego surgery in favor of “conservative measures.” “The results were significantly better than those for the 30 patients who ultimately required surgery.”
Most of the surgeries were total shoulder replacements. “About a third will need a repeat procedure if they expect a comfortable retirement,” says the article. “The 10-year survival of the implants was only 65.5%.”