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Is Nonsurgical Treatment for Rotator Cuff Tears a Long-Term Solution?

POSTED ON IN Latest News Shoulder BY Chris Centeno

nonsurgical treatment for rotator cuff tears

In today’s modern world, if you’re middle-aged and feel a sudden stabbing pain in your shoulder and then it continues to ache, you get an MRI. If that shoulder study shows a big enough rotator cuff tear, you’re quickly spirited off to surgery. However, what would happen if you never had the surgery? Would it be a disaster or would it be OK? That’s what a new study set out to discover, and the results may surprise you.

What Are Rotator Cuff Tears

The rotator cuff is a complex series of muscles and tendons that live in each shoulder. These muscles support the shoulder (a ball-and-socket joint), provide stability, and give you the ability to have a full rotational range of movement in your arms, especially when lifting. The rotator cuff muscles and tendons can tear. This can happen with an injury, especially with stress from an over-head motion (such as lifting) or in athletes, and it can also occur when wear and tear become more common in middle or older age. When we hear the word “tear” in relation to shoulder pain, our hopes of a nonsurgical treatment for rotator cuff tears often goes out the window and our first thought is that it must need to be sewn up, and indeed this is often what surgeons recommend. And if our MRI shows a full-thickness rotator cuff tear, this can even seem more in need of urgent surgical repair. But is it?

Why Surgery Shouldn’t Be a Given for Rotator Cuff Tears

After rotator cuff surgery, not only is it common for many patients to still be in pain but oftentimes their full range of motion is also never realized. This can be particularly frustrating for athletes who rely on their shoulder range of motion to stay in the game (yet only about half actually return to their same level of play prior to their injury). Most of the time, the primary reason patients undergo rotator cuff surgery in the first place is to relieve their shoulder pain, so why are some patients still in pain? One reason could be what many studies have discovered—that the shoulder pain that patient has prior to surgery doesn’t necessarily have anything to do with the rotator cuff tear found on the MRI, especially if the patient is middle age or older and their tear is a result of normal wear and tear with aging.

If the rotator cuff is torn with trauma or perhaps while performing an exercise motion, clearly the tear could be the reason for pain; however, this still doesn’t mean surgery should be a given. There is too much research out there today showing that surgery is often no more effective for rotator cuff tears than no surgery at all.

It doesn’t stop here, even with the larger rotator cuff tears, there is a reason to be concerned about surgery as research has shown that 6 out of 10 of these large rotator cuff surgical repairs actually fail, resulting in retears. One reason could be that with rotator cuff tears, depending on our gene expression, fewer native stem cells may be available to help with healing. And in those over the age of 60, one out of every three patients don’t heal at all following rotator cuff surgery.

Now a new study finds that not only can nonsurgical treatment for rotator cuff tears be effective, but it can be effective long-term.

Study Finds Nonsurgical Treatment for Rotator Cuff Tears Can Be Effective Long-Term

While we’ve seen many other studies showing that many rotator cuff tears can heal without surgery, today’s feature study not only confirmed these findings but also took it a step further, following up many years (5+) after the patients’ surgeries. The new study consisted of patients who’d had rotator cuff tears (full thickness) for greater than three months. All of the subjects took part in a “home-based treatment program” for a period of three months. Those who had successful outcomes were placed in the nonoperative group. Those who failed the home treatment underwent surgical repair. Both groups were followed for five years.

The result? At five years, 75% of the nonoperative group were still reporting successful outcomes (with a quality-of-life score of 83 out of 100). Of the initial nonoperative group five years prior, only 3 patients had gone on to require surgical repair.  The operative group quality-of-life score was 89 out of 100 at five years, and researchers stated this was not a significant difference from the nonsurgical group. They concluded that patients can do very well long-term with nonsurgical treatment for full-thickness rotator cuff tears.

I think it’s important to emphasize the point here. Patients who opted for the surgery fared no better than those who skipped the surgery! Yikes, this study is going to piss off some surgeons.

The upshot? I love studies that question the status quo, and this one is going to be an issue for many surgeons quick to operate on shoulder rotator cuff tears. If 75% of these patients will eventually be out of pain, why are we taking the increased risk of a surgical shoulder rotator cuff repair? Said another way from a medical-legal standpoint, if there’s a complication with shoulder surgery and the patient was never informed of research supporting that there’s a 75% chance that they would eventually be mostly pain-free with good function without the surgery, is the surgeon directly liable for that complication? This is going to get interesting…

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Robert M. Seale says

    I am an older patient who has recovered from a major rotator cuff tear. I had stem cell treatment by Regenexx in Boulder CO. in July, 2016. I am thrilled that there is no more pain now. I have full range of motion. The post-treatment physiotherapy regime prescribed by Regenexx was obtained locally after return from Colorado. The stem cell treatment worked wonders, and the prescribed physiotherapy hastened my recovery. Thank you Regenexx.

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    Tony Wiertel says

    Great story. I'm in a similar situation with both my knees. I am bone on bone with osteoarthritis in both knees and my orthopedic doctor wants me to have both knees replaced. I'm hesitant. I've undergone a Lipogems procedure. i did this about 9 weeks ago I'm seeing a little more comfort in terms of less pain. I pray for more research in non-surgical interventions such as your stem cell treatments and procedures like Lipogems. Insurance companies are still not covering stem cell (Regenexx) or Lipogems procedures. My Lipogems procedure was quite expensive (out of pocket). It's my hope and prayers that some day these non-surgical interventions will be long lasting. I very much enjoy reading your Regenexx articles. Keep up the good work.

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    Jan Tucci says

    I have chosen no surgery for rotator cuff tear as well as two torn meniscus...I shall have enriched plasma injected in knee...which is two year post stem cells in both knees.

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    E.C. Pasour, Jr. says

    What if the rotator cuff is completely torn...are there any nonsurgical approaches in such cases?

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    Regenexx Team says

    E.C.
    Yes. All patients go through a Candidacy review to see if they're a Candidate, but here's an example of a full thickness rotator cuff tear with some retraction: https://www.regenexx.com/avoid-rotator-cuff-surgery-2/ Please see: https://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

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    Ann-Marie Doerhoff says

    I too opted out of the surgery because of this type of data. I did have a truama injury but waited 2 years to have an MRI so by then I think there was a low probabliliy of a good outcome. I have good motion and low pain but am rather weak in this arm. I am worried about long term outcomes. I am considering the SCR with the Arthrex patch.

    Do you know where I could find data on the results for this procedure? Intuitively it makes sense to put a biological patch in the rotator cuff instead of stretching it back together. The recovery appears to be a lot quicker. I have heard a statistic that it takes 17 years on average for a treatment to become main stream. This was developed in the late 2000's.

    I would appreciate any thoughts on this option.

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    Regenexx Team says

    Anne-Marie,
    The Anthrex SCR is a very invasive arthroscopic surgical procedure pioneered by Dr. Teruhisa Mihata in 2007 for patients with irreparable rotator cuff tears. Before considering something that drastic, it would be important to see what's actually going on. We'd be glad to take a look. A good percentage of these issues can be addressed without surgery. Please see: https://www.regenexx.com/watch-advanced-image-guided-injection-shoulder-step-procedure-suite-dr-schultz/ or https://www.arthrex.com/resources/animation/kwHmylIu6kyO_gFOq5hQVg/superior-capsular-reconstruction and https://www.regenexx.com/avoid-rotator-cuff-surgery-2/ and https://www.regenexx.com/how-to-avoid-surgery-for-rotator-cuff/

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    Constance Essinger says

    Love your Regenex articles! These comments are Priceless. I also have a torn rotator cuff which the surgeon thought I needed immediate surgery and I said “no”. It has been nine months and with electrical stimulation I feel great. When it was diagnosed I thought it was from playing tennis but I had more pain when I wasn’t playing tennis which the doctors could not understand . Keep the research coming. I follow you closely and so appreciate all your work.

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    Regenexx Team says

    Thanks Constance!

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    Lynn Maguire says

    I am 83 yrs old and my MRI showed a massive rotator cuff tear plus some other related problems. I Orhopedic surgeon said surgury was not an option and suggested physical therapy and a pain management clinic. What could I expect from your treatment .

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    Regenexx Team says

    Lynn,
    We'd need more information through the Candidacy process to answer your question regarding your specific case. Age would not be an issue. If you'd like us to do that, please submit the "Are You a Candidate" form. Please see: https://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ and https://www.regenexx.com/avoid-rotator-cuff-surgery-2/

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    Phyllis Lane says

    Need more info.........tried to Google it with no results. Need 2 shoulder replacements but can't get them. Using shots of Synvisc. Want to know more. Tears in rotator cuff extreme. Please direct me. I live in Rockland County New York.

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    Regenexx Team says

    Phyllis,
    Synvisc is fine, but it's important to avoid steroid shots. Here is some additional information on how we treat shoulders (please scroll all the way down) : https://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ If you would like to see if you would be a Candidate, please submit the "Are you a Candidate" form. Here are some rotator cuff tear cases: https://www.regenexx.com/shoulder-stem-cell-injection/ and https://www.regenexx.com/avoid-rotator-cuff-surgery-2/ and https://www.regenexx.com/helping-another-shoulder-rotator-cuff-tear-heal/

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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