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The shoulder business is more what I would call elective surgery here in ski country. In the fall and the spring, I typically see 2-3 rotator cuff tears per week. In the winter, less people want to have shoulder surgery so they often wait until the end of the season to have these injuries evaluated.
The rotator cuff is a group of four muscles and their tendons that stabilize and rotate the shoulder. 80% of the rotator cuff tears I see are degenerative. The typical rotator cuff injury patient is middle aged or older and leads a very active lifestyle.
As you get older, the blood supply to these tendons decreases, leaving them more susceptible to degenerative tearing. Rotator cuff tears come in many varieties. Most often, a rotator cuff tear begins slowly and will continue to tear further with continual use. Sometimes patients come to see me right away with a partial tear; other times they wait and don’t see me until they have a complete tear.
In the past, surgeons have repaired a partially torn rotator cuff by operating from above the cuff and actually completing the tear during surgery and then repairing it as though it was a complete tear. Because the surgery was for the most part the same whether you had a partial or full thickness tear, deciding whether or not to operate on a partial tear was difficult.
When you have a complete tear in an active person, the decision to go ahead with surgery is fairly simple. But with partial tears, the decision process is more complicated. Do you give it time and let it come all the way to failure? Or do you choose to be aggressive and fix it right away?
But now a new surgical technique being utilized by some surgeons is starting to change that. I have started using what’s called a ‘trans cuff’ technique. Instead of operating on the rotator cuff from above and completing the tear, I can now look at the part of the cuff that is torn from underneath, put anchors in it from that underneath location, and repair just the tear itself. The technique allows the fibers that are still there to remain attached. We are now repairing just the part of the cuff that was torn.
The new technique is making the decision to have surgery that much easier for active people suffering from a partial tear. What it means for patients is a shorter recovery time, an equally good outcome, and an earlier return to sports and activities. It also expedites physical therapy since we can get patients into therapy that much sooner and be that more aggressive with their rehab program.
The real advantage is that patients can be a more aggressive with their decision to have surgery and stop the progression of the tear so that we’re not dealing with a full thickness tear down the road. It’s a nice middle ground.