Will a rotator cuff tear heal on it’s own? Will a rotator cuff tear get bigger without surgical repair? These are the questions asked by many of the 40,000 patients each year that opt for surgery to repair their torn rotator cuff. Obviously, the answers to these queries factor into whether a patient decides to have surgery or wait. First, as I’ve blogged before, there isn’t much good research that supports that surgery is very effective for rotator cuff tears. In addition, in larger tears of the rotator cuff, approximately 6 in 10 don’t heal with surgery. Finally, shoulder surgery recovery is difficult in patients over 60, with 1 in 3 rotator cuff tears not healing in that age group. Second, what if the research showed that even a complete tear isn’t very likely to get bigger? Well a new study out this week just looked at that issue. In this case, 24 patients who had full thickness supraspinatus tears and who opted to forego surgery were tracked over time. In 2 of the 24 patients, the rotator cuff tear completely healed on it’s own and in 9/24 the tear was smaller. In 9/24 patients the rotator cuff tear size didn’t change and in 6/24 patients the tear was bigger. So in 75% of the patients, the tear was either healed, smaller, or didn’t change. How about muscle atrophy? This phenomenon can occur and involves the rotator cuff muscles shrinking and being replaced by fat. While there was a slight trend in that direction, no patient had serious fatty atrophy at follow-up. In addition, this study is consistent with another study that shows that the size of a rotator cuff tear is more likely than not to stay stable. The upshot? Surgeons frequently tell patients that their rotator cuff tears will get bigger over time, hence the reason for operating right now. In fact, according to this study (and others), waiting to see if the tear heals or gets smaller might make allot of sense. In addition, this window of opportunity would allow many patients to avail themselves of newer biologic injection therapies under ultrasound guidance using PRP or stem cells. You may want to see if these non-surgical approaches work before trying more invasive surgery that may provide little benefit.
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