Naples Orthopedic Surgeon – Dr. Robert J. Zehr The Zehr Center

Mother is 77-years young (as she likes to say) and very active. She tore her rotator cuff playing tennis and had surgery to repair it. Unfortunately, it’s been six months and she still has not regained her motion. Her shoulder pain seems worse than before the operation. Is this typical in someone her age?

It may be difficult to answer your question directly without knowing more about the shoulder injury and type of surgery done. In general, older adults have degenerative changes in the joint and soft tissues around the joint. Rotator cuff tears (RCTs) are common.

There can be tears in the joint cartilage or just frayed edges that need smoothing down. Sometimes repairing the torn rotator cuff is all that’s needed. If the torn cartilage isn’t bothering the patient, then it’s not always in their best interest to repair it. The result can be the loss of motion and worsening of symptoms you described.

In other cases, the rehab program after surgery is the key factor. The patient must follow the surgeon’s and the physical therapist’s directions carefully. Too much movement too soon can cause the repair to fail. With the right program, loss of shoulder motion can be avoided.

It might be best to make a follow-up appointment with the surgeon and go with your mother. Her age may be a factor; sometimes older adults just need more time to progress through the rehab program. She may need an extra step in the rehab process.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

I’ve heard it’s possible to rehab a torn rotator cuff without surgery. How is that possible?

The rotator cuff is a group of four muscles and tendons that converge on the shoulder. Together they form a sheath or envelope that wraps around the shoulder. The fibers interlock and crossover forming layers that are all connected together.

This protective overlap makes it possible for one muscle to take over and help function for another. This concept is called redundancy in function. Rehab can focus on strengthening the muscles that aren’t torn and restoring the torn tendons as much as possible.

A physical therapist can perform a special massage called transverse friction massage to help align the healing fibers. Instead of adhesions and scarring going in all directions, the fibers line up in parallel. This helps keep the shoulder supple and moving smoothly.

Not all tears do heal without surgery. Various factors such as patient age, condition of the tissue, and depth of the tear determine the final outcome. Results also depend on whether more than one tendon is involved and the location of the tears.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

My 72-year old mother has been told her torn rotator cuff cannot be repaired. She seems in good health and she’s fairly active for her age. Why can’t this be fixed?

Massive, chronic tears of the rotator cuff (RCTs) can’t be repaired in the standard, conventional way of reattaching the torn tendon where it belongs. In older adults, the tear may have been present for so long that the area has filled in with fatty tissue. In such cases, the rate of retear is very high when a repair is attempted.

Treatment is possible but just what’s the best treatment is judged on a case-by-case basis. After the surgeon examines the patient, imaging studies are taken. X-rays, CT scans, and MRIs each give a slightly different view of what’s going on inside and around the shoulder joint.

Arthritis in the joint makes the treatment decision more difficult. The patient’s age, activity level, amount of muscle atrophy, and fatty infiltration are all taken into consideration. Sometimes the best treatment plan is nonoperative. Inflammatories, steroid injections, and physical therapy may be advised.

When surgery is recommended, it may be to debride the area (clean it up). Or a tendon transfer may be possible. In this case, the surgeon takes a muscle from some other area and transfers it to the shoulder. The transferred tendon functions like the torn tendon of the rotator cuff. A tendon transfer is a complex operation. A long rehab program is likely so the patient must be motivated and active enough to do it before tendon transfer is considered.

When the shoulder is unstable and the rotator cuff tear is inoperable, then a shoulder replacement may be the best treatment choice. Many irreparable RCTs can be managed nonoperatively. This may be what your mother’s surgeon was suggesting.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.