Rotator cuff tears: You can heal without surgery
Each year, approximately 200,000 Americans undergo shoulder surgery to repair a torn rotator cuff. Post surgery, the average time wearing a sling is 4 months, and recovery takes approximately 11 months.1
That is a lot of surgery, and a lot of recovery time. Unfortunately, surgery does not guarantee healing or complete recovery.
Therefore, an important question is: Can a rotator cuff injury heal without surgery? The answer is yes. And for many rotator cuff tears, successful recovery without surgery is likely when regenerative treatments are used to assist the body’s own healing. Nonsurgical regenerative treatment of a rotator cuff tear incurs lower costs and returns you to normal activity faster than surgery.
Recent studies show that patients opting for conservative treatments, including physical therapy and regenerative medicine, demonstrate high satisfaction, improvement in function, and successfully avoid surgery.2
What is the rotator cuff?
The “rotator cuff” actually isn’t one thing in the body. It is a collection of muscles and tendons that work in concert to provide stability and movement of the shoulder. These muscles and their corresponding tendons are supraspinatus, infraspinatus, teres minor, and subscapularis. Their acronym is SITS.
These muscles are small but mighty. About the size of tendons themselves, they provide stability to the glenohumeral joint. This is the joint where the humerus (arm) meets the glenoid (scapula or shoulder blade).
Unlike the hip, where the femoral head inserts into a deeply concave area of the acetabular fossa, the glenoid fossa is nearly flat. Think of a golf ball (humeral head) resting on a golf tee (glenoid fossa).
There is a second joint area, acromioclavicular joint, which also makes up the shoulder. The acromion is also part of the scapula and attaches to the clavicle, which is on the anterior side (front) of the shoulder.
These SITS muscles have to attach the scapula to the arm and to the clavicle.
While providing structure to the shoulder, the SITS muscles are also essential in the movement of the shoulder. The muscles that make up the rotator cuff are asked to do a lot over a lifetime. Therefore, risk of injury increases with age.
What happens when there is a rotator cuff tear or injury or pain?
After an injury, the pain is described as a dull, deep ache in the shoulder. It is also accompanied by arm weakness. The injury makes it difficult to reach behind your back or to brush your hair. The pain makes sleeping uncomfortable, especially if you lie on your side.
Injuries are often the result of daily “wear and tear,” especially with jobs like carpentry, painting, or hair styling that require a lot of overhead work, as well as sports like baseball, tennis, and swimming. They also arise from traumatic falls or from lifting heavy objects.
Supraspinatus tends to sustain most of the injuries to this group because of its relative size and attachment to the humerus. It holds your arm in place and helps you lift your arm.
How is a rotator cuff tear diagnosed?
Often pain in the shoulder can arise from other areas, like the neck or elbow, or from other structures or tissues within the shoulder. Therefore, proper diagnosis before undergoing any invasive treatment is critical.
Much of the diagnosis comes through palpation, range of motion examination, and strength testing. Imaging may be recommended, to include x-ray, ultrasound, and/or MRI (magnetic resonance imaging).
Note that the muscles and tendons themselves are not seen on x-ray. However, calcifications and bony deformations are, which can be the cause of rotator cuff pathology.
The typical injuries to the rotator cuff soft tissues include tears, tendonitis, and impingement syndrome.
How is the injury treated surgically?
Surgical options include trimming or smoothing (debridement) for partial tears; suturing the two sides of the tendon for larger tears; and if the tendon is torn from its insertion on the humerus, it can be repaired directly to bone. Some surgeons may also remove a portion of the acromion.
The most common complications are tendon retearing, joint stiffness, nerve injury, and infection.
Does surgery guarantee that rotator cuff tears will heal?
When surgery is recommended, however, it is important to understand that the injury may heal without it and may not heal with it.
Despite the advances in surgical techniques, retear after rotator cuff surgery is a common problem. Research shows that recurrent tears after rotator cuff repair range between 20% and 40% for small-to-medium tears and as high as 94% for large or chronic tears.3
Another common concern is worsening of the tear without surgery. Research of athletes who use aggressive overhead motions shows that most tears, even those that cause symptoms, are often effectively treated without surgery. Furthermore, surgical repair fails to return 50% of these athletes to the same level of performance.4 With the improvement in nonoperative management, as well as the high failure rate of return to the same performance, nonsurgical therapies are recommended.
In addition, a recent research study showed that even a complete tear isn’t very likely to get bigger with just a conservative approach.5
During this study, 24 patients who had full thickness supraspinatus tears and who opted to forego surgery were tracked over time. Two of the 24 patients, the rotator cuff tear completely healed on its own. In 9 of the 24, the tear was smaller; while another 9 out of the 24 patients the rotator cuff tear size didn’t change. And in only 6 of the 24 patients, the tear was found to be bigger. So in 75% of the patients, the tear was either healed, smaller, or didn’t change.
The other consideration is how likely will the injury recur post surgery. Conservative healing offers less of a chance of retear compared to surgery. Remember, surgery is sewing soft tissues together. Therefore, there is a high rate of retearing.
What are the regenerative treatment options?
Combining rest and physical therapy, with the power of regenerative medicine, you’re giving your body a fighting chance to heal as closely to what nature intended.
Regenerative techniques take your body’s healing power and concentrates it to the epicenter of injury, so your cells can focus on the injury.
The most common regenerative techniques for rotator cuff healing are platelet-rich plasma or stem cell treatments. Stem cells are a special type of cell that can transform itself into a specific cell based on the need of its surroundings. Under certain conditions, they can divide to repair and replace worn out tissues.
They can be employed early in the process to speed healing without surgery. Furthermore, regenerative medicine can used to aid in recovering from surgery.
Humans have been on the planet for millenia, designed to survive and withstand the elements of nature. There are innate or built-in processes in these bodies that are designed to heal for survival.
Regenerative medicine enhances these processes so that the body can heal without invasive traumatic surgery.
Will rotator cuff tears heal without surgery?
Yes. As the studies outline above, about 70-80% of these injuries can heal without surgery. Furthermore, they may heal better without surgery. And with the assistance of regenerative medicine, not only do these injuries heal faster, they heal more completely. Rotator cuff retear rates fell by half when stem cell injections were used combined surgery, according to a recent study.
As with any diagnosis, it’s a “best guess” that what the doctor sees on the radiographic studies is actually the cause of the patient’s pain. In other words, if there is pain that is coming from the neck and there happens to be an asymptomatic tear, which is very common, the doctor may see the tear and attribute the pain to the tear. If that tear then undergoes surgical intervention and it wasn’t the source of pain or weakness, then the symptoms will not be alleviated after recovery from surgery.
There is limited evidence to suggest that surgery is more effective in treating rotator cuff pathologies than conservative treatment alone.6 Thus, a nonsurgical approach is advised. Furthermore, with regenerative techniques boosting the body’s healing ability, combined with therapeutic exercises, not only can surgery be avoided, but the injury can likely heal to a state better than it was before the injury.