These are common questions asked by many of the 40,000 patients each year that opt for surgery to repair their torn rotator cuff. The answers to these queries contribute to a patient’s decision on whether to have surgery, but may also create a sense of urgency to jump into a procedure that may very well be unnecessary.
As we have discussed in many articles before, there is a good amount of research showing that surgery is largely ineffective for many types of rotator cuff tears. And in larger tears of the rotator cuff, approximately 6 in 10 don’t heal properly, even with surgery.
Many surgical patients never recover full range of motion following surgery. For patients over 60, shoulder surgery recovery is even more difficult, with 1 in 3 rotator cuff tears not healing in that age group.
A recent research study showed that even a complete tear wasn’t very likely to get bigger. In this study, 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 its own. In 9 of the 24 the tear was smaller. In another 9 out of the 24 patients the rotator cuff tear size didn’t change. 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.
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.
Using the data from the studies above, it is safe to say that a few rotator cuff tears will heal on their own without intervention and that surgery really isn’t that great of an option.
One of the problems with surgery is that when a rotator cuff tears on its own, or with minor trauma, the tissue has become very unhealthy. This is caused by the structure of the tendon becoming weak and degenerated. Based on new research, rotator cuff tears are linked to a reduction in the natural number of functional stem cells in the tissue. While this may come as a surprise that your body maintains itself via adult stem cells living in tissue, that’s how it works.
For this reason, surgically sewing together a tear can be like sewing damaged tissue paper to damaged tissue paper, which is why we see very high retear rates after surgery. And unless something is done to replace the lack of stem cells needed for healing, the tissue can’t repair itself with the same ability as when it was young. One recent study showed that the rotator cuff retear rates fell by half when stem cell injections were used after surgery.
Rotator cuff tears are one of the most commonly treated conditions across the Regenexx Network and we consistently see good outcomes in these patients. Having said that, while most tears will heal with just a precise injection, there are a few massive rotator cuff tears that are unlikely to be helped without surgery. Keep in mind that even after surgery, stem cell injections, as discussed in the study above, will likely assist in the healing and improvement of tissue health following surgery.
The upshot? Surgeons frequently tell patients that their rotator cuff tears will get bigger over time if surgery isn’t performed immediately. According to research, waiting to see if the tear heals or gets smaller might make a lot of sense. If you’re like most people with a rotator cuff tear, you will likely be able to skip the invasive surgery altogether! Lastly, to ensure the best chance of success, select a Regenexx Network Physician, who are all trained in ultra-precise injection techniques, and will determine whether the Regenexx patented stem cell protocol or super concentrated platelet rich plasma is the best treatment option for the severity and condition of your rotator cuff tear.
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The information above includes treatments for additional shoulder conditions. For an infographic on a smaller number of Rotator Cuff tear patients only, click here.
About the Author
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.…