Expert Commentary: Stephen A. Baker, M.D. - 7/27/2009
Those who present to their Orthopaedic Surgeon with a symptomatic rotator cuff tear do so because of pain and/or weakness. Since tears of the rotator cuff do not have the capacity to heal spontaneously and since most tears arise from tendon tissue with an already compromised blood supply (an adequate blood supply being a requisite for healing), it stands to reason that a tear will usually enlarge over time.
This study also points out that those who have had a repair which subsequently fails or re-tears experience a far better functional result than had they not had the procedure. The reason for this unexpected benefit is most likely related to the structured use of a well thought-out post-operative rehabilitation program. These programs emphasize not only strengthening the repaired muscles and tendons but also place an emphasis on proper body mechanics and strengthening the secondary shoulder stabilizers and core muscles as well.
It is for this reason that we will often recommend a trial course of physical therapy prior to embarking on a repair for a large or massive rotator cuff tear in an older individual who may have fewer physical demands than their younger counterparts.
Although surgical repair of the rotator cuff is not an urgent matter, it should be done in a timely fashion. Given that this surgery is rarely an emergency situation, it allows the patient time to do their own research and to find the best surgeon possible. Checking referrals and doing research online can help patients make an educated choice as they approach surgery.
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