Expert Commentary: Gregory Portland, M.D. 11/23/2009

Posted by Admin on November 22, 2009
Torn rotator cuff tendons are among the most common conditions shoulder specialists face. Decisions to fix a torn tendon are predicated on a patient's age, occupation, activity level, weakness, and pain. Pain, in my experience, is the number one motivator to proceed with surgery.

The most common surgical risk patients face is failure of their repair. Post surgical MRI scans and/or ultrasound scans have shown recurrence rates greater than 30% for large tears. However, most patients with a recurrent tear have significant improvement in pain and function.

The study by Dodson et al will be very helpful for the management of patients with suspected failure of their rotator cuff repair. To hear their tear has recurred may be psychologically taxing to patients despite improved pain relief and strength. The decision to leave the recurrent tear alone and follow clinically is better supported knowing up to eight years of pain relief were observed in this study. Long-term follow-up of this subset of fifteen patients should be interesting.

In summary:

  1. Don’t get a torn rotator cuff fixed unless you have pain. Repairs may fail, and why put yourself through a repair if you don’t hurt!! The only exception would be if substantially weakness exists.
  2. Successful results from your doctor’s standpoint will be based on your pain relief and improved function. There is no role for follow-up MRI and/or ultrasound after rotator cuff surgery if the patient is doing better.
  3. Repairs have long term benefits (even if there is tear recurrence)

Gregory Portland, MD

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