Rotator Cuff Tears and Re-tears

New research shows 57% failure rate in Large Rotator Cuff Repairs

There has long been a debate over the effectiveness of rotator cuff tear surgery. Numerous medical studies have shown that the re-tear rate of a surgically repaired shoulder could be anywhere from 20 – 90% depending on the patient circumstance. Now Australian researchers, presenting at the American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting (February 2012) say that the failure rate they measured in 500 patients was 57%.

A different option – rebuild the shoulder without surgery
Shoulder injuries can be divided into two groups – more commonly is the wear and tear injury to the tendons. The shoulder tendons are main players in rotator cuff problems, shoulder impingement, osteoarthritis and disorders of pain and weakness that get worse over time.

The second scenario involving tendon damage is in the event of catastrophic injury that results in up to 100% tearing of the rotator cuff tendons in previously healthy shoulders. These are injuries that occur in sports, car accidents or a situation where the shoulder is exposed to sudden extreme force.

Prolotherapy and PRP (Platelet Rich Plasma therapy) are injection therapies that a trained physician will gently inject into the shoulder hoping to accelerate the body’s own inflammatory response to repair the tendons.

By isolating the areas of the tendons that are damaged, and injecting these spots, the doctor is calling the natural injury repair mechanism of the body to the spot of deterioration. The cure is the new, controlled inflammation. This will stimulate a new collagen matrix, making the tendons stronger, thicker, and restoring them to their normal pain free state.

Even in 100% tears Prolotherapy and PRP may be the preferred treatment and help prevent retearing. In this scenario, surgery to repair devastated tissue might be the only option. Prolotherapy can accelerate healing and strengthening of the surrounding ligaments and tendons that are usually stretched or partially torn in such an impact injury.

A proper diagnosis of shoulder pain is essential to determine the root cause of the problem and the proper method of treatment. Because many shoulder conditions are caused by specific activities, a detailed medical history is an invaluable tool. A physical examination should also include screening for physical abnormalities—swelling, deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved.

Please consider coming in for an appointment. You can call our office at anytime or simply send us an email and we’ll call you if you like! We’re truly looking forward to helping you to live pain free!

Darrow Sports & Wellness
11645 Wilshire Blvd
Los Angeles, CA
(310) 231-7000

Does your young athlete really need shoulder surgery?

Does your young athlete really need shoulder surgery?
Twenty-one percent failure rate?

Research in the medical journal Arthroscopy reported the following as they investigated the outcome of arthroscopic capsular repair for shoulder instability in an active adolescent population participating in overhead or contact sports.

“Arthroscopic stabilization is a reasonable surgical option even in an adolescent population performing sports activities. However, it must be emphasized to the patients and their relatives that the recurrence rate that could be expected after an arthroscopic procedure is higher than in the adult population.”

Here are the numbers: 65 patients – 44 male, 21 female. Avergae age 16. Arthroscopic capsulolabral repair was performed after at least 6 months of failed nonoperative treatment. (See below on waiting 6 months). The average follow-up was 63 months. (5 years later).

Following procedure 81% of the patients returned to their preinjury level of sport, and the rate of failure was 21%.

Castagna A, Delle Rose G, Borroni M, et al. Arthroscopic Stabilization of the Shoulder in Adolescent Athletes Participating in Overhead or Contact Sports. Arthroscopy. 2011 Nov 28. [Epub ahead of print]

Fixing shoulder problems non-surgically.

Is shoulder surgery the only answer for the athlete who wants a quick return to their sport? To many athletes the answer is yes because the alternative recommendations from their orthopedic specialist of ice, rest, physical therapy and wait six months is not the option they want.

Isn’t surgery the fastest way back?

A patient with problems of the rotator cuff or shoulder impingement may think so, however surgery is a still an invasive procedure that requires lengthy recovery and physical therapy even if successful. Further, even successful surgery has been shown to not always relieve all the pain and that shoulder weakness can remain. Complications may also include nerve damage.

A different option – rebuild the shoulder without surgery Shoulder injuries can be divided into two groups – more commonly, and the first to be discussed is the wear and tear injury to the tendons. The shoulder tendons are main players in rotator cuff problems, shoulder impingement, osteoarthritis and disorders of pain and weakness that get worse over time.

The symptoms of tendon weakness and injury are many and include inflammation of the tendons ( tendonitis), and/or bursitis, inflammation of the bursa (the protective sac that sits between the bones of the shoulders and allows the tendons the space they need to move.)

All would agree treating the tendons and allowing the tendons to function normally would be the optimal treatment in shoulder pain, but that is where the agreement ends. Surgeons will insist that surgery after failed conservative treatments is the way to go, other doctors are trying something else for faster results.

Prolotherapy is an injection therapy consisting mainly of dextrose, an irritant. A physician, and there are only about 500 in the United States who perform this treatment, will gently inject areas of the shoulder hoping to accelerate the body’s own inflammatory response to repair the tendons.

By isolating the areas of the tendons that are damaged, and injecting these spots, the Prolotherapist is calling the natural injury repair mechanism of the body to the spot of deterioration. The cure is the new, controlled inflammation, created by dextrose. This will stimulate a new collagen matrix, making the tendons stronger, thicker, and restoring them to their normal pain free state. To any athlete stronger is always the best option.

Prolotherapy can work fast, a treatment once a week over a 4 – 6 week period is usually all that is needed to see results. Side-effects are also limited and in many cases the athlete can continue their activities during treatments.

Prolotherapy with surgery? The second scenario involving tendon damage is in the event of catastrophic injury that results in 100% tearing of the rotator cuff tendons in previously healthy shoulders. These are injuries that occur in sports, car accidents or a situation where the shoulder is exposed to sudden extreme force.

Even in these injuries Prolotherapy, may be the preferred treatment. However in this scenario, surgery to repair devastated tissue might be the only option. Even so, Prolotherapy can accelerate healing and strengthening of the surrounding ligaments and tendons that are usually stretched or partially torn in such an impact injury.

To learn more about Dr. Darrow, PRP Therapy, and Prolotherapy, as well as the Darrow Sports and Wellness Institute, visit the very best Prolotherapy injections clinic today, or call our 11645 Wilshire Blvd. #120 LA, CA 90025 office at 310-231-7000.

Subacromial impingement syndrome

The shoulder is really a combination of several joints, combined in such a way by an intricate arrangement of muscles and tendons, that provides the arm a wide range of motion, flexibility and stability.

The rotator cuff is a group of four shoulder muscles that surround the top of the upper arm bone, the humerus, and holds it in the shoulder joint. These muscles are responsible for moving the arm in various directions, and unlike the massive deltoid muscle of the upper arm, are smaller and generally more vulnerable to injury. The four muscles and tendons of the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis. It is the supraspinatus that is most commonly inflamed or torn.

The supraspinatus, and the rest of the shoulder, because they are built and expected to allow a remarkable array of motion, frequently are subjected to injuries, causing problems of instability or impingement of soft tissue and in pain. The pain may be constant, or may occur only when the shoulder is moved. In any case, any shoulder pain that persists more than a few days should be diagnosed and treated as necessary.

Shoulder impingement syndrome involves one or a combination of problems: inflammation and/or swelling of the bursa located just over the rotator cuff, inflammation of the rotator cuff tendons (tendonitis), or calcium deposits in tendons—called calcific tendonitis, (caused by wear and tear or injury). The main problem is usually that the acromium or a bone spur puts pressure on the supraspinatus tendon. This type of injury usually occurs as a result of wear and tear. Typically in athletes whose sport requires repetitive overhead movements such as serving in tennis, swimming, strength training or weight lifting, and golfing. This injury is also seen frequently in baseball pitchers and basketball players, where a great deal of overhead arm motion is required.

The symptoms include pain from the shoulder to the elbow, especially when the arm is raised above the head, reduced arm strength and range of motion without pain.

Because inflammation is present, a patient will usually be told to immobilize the area to prevent further irritation and inflammation, and be prescribed anti-inflammatory medications and perhaps a cortisone injection. Treatments whose side effects and long-term effect on injured joints have been well documented.

How about surgery?
Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review. Arch Phys Med Rehabil. 2011 Nov;92(11):1900-13.

“This (study) shows that there is no evidence that surgical treatment is superior to conservative treatment or that 1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure.”

Prolotherapy and PRP
Shoulder injuries can be broken into two categories, both of which can be successfully treated with prolotherapy and/or PRP (Platelet Rich Plasma) shoulder injections. The first category contains the common injuries cause by normal wear and tear. These injuries affect the tendons, which are main players in problems relating to rotator cuffs, shoulder impingement, osteoarthritis, and other disorders that cause pain or weakness, worsening with time. The symptoms of these injuries include tendon inflammation, tendonitis, and bursitis. Many turn to surgery for these common problems when prolotherapy shoulder treatments are safer and more convenient. Prolotherapy uses the body’s natural healing functions to regenerate soft tissues, limiting side effects and increasing immune properties.

The second type of shoulder injury is more serious, and involves completely tearing the tendon. This type of injury only occurs in extreme cases, such as a car accident, long fall, or rough sports. In rare cases prolotherapy shoulder injections could treat these injuries as the sole method of treatment. In many cases of this severity, however, surgery may be the only option. Even if this is the case, prolotherapy can help. Shoulder injections after surgery can accelerate the healing process and strengthen the ligaments and tendons.

To determine the actual cause of pain and decide upon an appropriate treatment plan it is necessary to first get a proper diagnosis. Help your prolotherapist make that diagnosis by providing a complete and accurate medical history. Many cases of shoulder damage are the result of repeated or ongoing instances, so it is necessary to detail the specific activities involved in causing discomfort.

Contact our office to see if Prolotherapy and/or PRP can help your shoulder pain.