Options for Patients with Irreparable Rotator Cuff Tears
ROTATOR CUFF TEARS
These are the most common cause of disabling shoulder pain. Persons with these tears often complain of shoulder pain with activities, but often progress to pain at rest and most notably at night. This night pain interferes with sleep which often leads to an evaluation by an Orthopaedic Surgeon. Rotator cuff tears come in an variety of shapes and sizes. Most tears are not the result of a single traumatic event, but instead happen over the course of years with many smaller injuries. A person may tear a few fibers of the millions that make up the tendons of the rotator cuff and when these injuries accumulate a full tear can result. Because these injuries happen over the course of time, they often learn to live with suboptimal function until a threshold is passed and they lose all function.
When these persons present, it is not unusual to discover that they have a tear of the rotator cuff that is not repairable. It is very difficult to tell these patients that there is nothing that can be done for them. Until recently, this is what we would have to tell this person.
REVERSE TOTAL SHOULDER REPLACEMENT
In 2003, the FDA approved US surgeons to use the Reverse Total Shoulder Replacement.
This procedure was specifically designed to deal with this difficult problem and it has had life changing success for many patients. However, it is only useful in “older” persons as it will not last the lifetime of a person who is in their forties or fifties. So we still had a significant population of patients for whom we did not have any good options to offer them.
In the last year, some highly skilled surgeons have developed the Superior Capsular Reconstruction. This procedure is designed specifically for this younger patient with an irreparable rotator cuff tear. The typical cuff tear involves the supraspinatus tendon which is the cuff tendon on the top of the shoulder.
When this tendon is torn, the humeral head will rise up abnormally and “lock” the shoulder. This typically results in severe pain, The Superior Capsular Reconstruction is designed to hold the humerus down and prevents it from rising up against the acromium. Early results are very promising in terms of restoring function and decreasing pain for these persons that previously did not have any options.
This is a very technically demanding procedure and only the most skilled shoulder arthroscopist have attempted to tackle it.
If you have been told that you have a irreparable rotator cuff, I am happy to evaluate you and determine if Superior Capsular Reconstruction is a reasonable option for you. You may call my office at 719-632-7669 for an appointment. Please bring any X-rays or MRI’s that have been performed to your appointment. Or, if you live at a distance from Colorado Springs, I am happy to review your studies and do a phone consultation with you. Simply send me your studies and I will review and give you a call.
Christopher Jones, MD
Colorado Springs Orthopaedic Group