Rotator Cuff Tears: Prevention is Better than the Solution
4.5 million patients seek medical care each year for shoulder pain in the U.S. About half of these are related to the rotator cuff. Of those with rotator cuff problems, about 1 in 7 eventually require surgery. This translates to more than 300,000 rotator cuff surgeries are done each year in the U.S.
Rotator cuff tears are usually the result of natural aging processes. Not all rotator cuff tears are symptomatic. However, when they do become symptomatic, it may be quite painful and debilitating that impacts not just one’s ability to care for oneself , but affects the perception of one’s own health. Sleep is interrupted due to pain in the night. Time lost from work takes a toll both emotionally and financially. A burden on the patient’s family, friends, and society in general. Individual costs for non-operative management of shoulder ailments ( doctor visits, medication, X rays, MRI’s, and physical therapy) can approach $5000 range. For those who have failed non-operative management and go on to have surgery, with rotatorthe additional costs of surgery, anesthesia, surgical center costs, more medication, and more physical therapy, the final economic burden can be driven close to $40,000 per patient.
As a natural aging process, due to “wear and tear” and the innate degenerative processes that accompany “getting old”, 50% of those over age 80 years are expected to have full thickness tears without even being aware of it. But, the process of progressive tearing from partial to full thickness takes time and may have started years prior. Just like fraying of the fabric of your jeans, they start small and eventually shows frank separation. Between ages 50 and 59, 10% have tears with no symptoms. This rises to 25% for those between ages 60 and 70 ( or about 10 million people in the U.S. ) have asymptomatic full thickness rotator cuff tears. Although initially may be asymptomatic , but 9% of those with tears eventually become symptomatic each year. More than 50% will be expected to experience debilitating pain, weakness, and inability to sleep due to night pain by 6 years.
Although patient satisfaction, when measured in terms of alleviation of pain can be rated good to excellent in 87% to 97% of patients after surgical repair for a torn rotator cuff tendon, functional return of strength is unpredictable and up to 25% of repairs never heal. Successful long term results over 5 years, in some studies can be a dismal 55%. Less satisfactory results are correlated with older rotator2 age, larger tear size, and the longer the time the tear has been present. Smoking and other metabolic / circulatory factors also play a role in healing of the tendon after surgery.
However, not all is lost. SIGNIFICANT predictors of good functional outcome after surgical repair are related to PRESURGICAL levels of muscle atrophy. The atrophied muscle prior to surgery may not improve even up to one year after surgery. And in fact, the muscle atrophy frequently gets even worse in spite of surgical repair if the muscles were atrophied to begin with at the time of surgery. This indicates the importance of maintenance of muscle mass of the rotator cuff by regular rotator cuff specific exercises before tears occur. We may have no control over aging and certain metabolic diseases that predispose to things that ” just fall apart”, but we do have control over how we maintain our rotator cuff muscles. Maintenance of your body is as important as maintenance of your car.
If surgery is inevitable, at least you will be ready for it when it happens. Better to have good muscle mass going into the operating room than with no muscle mass.