Rotator cuff injuries don’t just happen to tennis players and baseball pitchers. The rotator cuff, a group of muscles and tendons that surround the shoulder joint, can also be torn by falling on the shoulder or lifting something heavy, and sometimes tears result from wear on the tendon due to aging. Symptoms of a tear include pain when lifting an arm, discomfort sleeping on the injured side and mild arm weakness.
Large rotator cuff tears typically can’t be repaired and, until recently, treatment options were limited to either symptom management with medications and physical therapy or a reverse total shoulder replacement. That surgery relieves pain and restores function but comes with significant limitations and activity restrictions.
“When any tendon is torn, surrounding muscles start to retract and degenerate,” says Beau Sasser, M.D., board-certified orthopaedic surgeon at Summit Sports Medicine & Orthopaedic Surgery, a strategic affiliate of Southeast Georgia Health System. “When the rotator cuff muscles aren’t used, they atrophy and turn to fat. Between that and the scarring, it is difficult to reposition the tendon where it needs to be.”
Older patients, those in their 70s and 80s, with significant chronic tears may benefit most from a reverse total shoulder replacement, which uses the deltoid – the rounded muscle on the upper shoulder – to support an artificial joint and power and position the arm. But for younger patients in their 40s, 50s and 60s, who are still working and leading active lives, this technique is typically not the best option.
“This surgery relies on a mechanical device, so younger patients are likely to wear it out,” explains Dr. Sasser. “Plus, there are restrictions on lifting, pushing and pulling, so patients are required to modify job activities following surgery. And, it’s a big surgery so there’s always the risk of complications.”
Enter the superior capsular reconstruction (SCR) procedure, which Dr. Sasser has been performing on eligible patients for the last two years. SCR uses a piece of tendon from a donor or another part of the patient’s body to fill the gap where the rotator cuff used to be.
“Utilizing a tendon instead of a mechanical device creates a ‘trampoline’ effect, keeping the upper arm bone down and correcting the shoulder’s mechanics,” he says. “This decreases pain and increases function. And, this method is more resilient to wear and tear than an artificial replacement. If you do eventually wear it out, the reverse total replacement is an option when you’re older.”
A promising, potentially transformative procedure
Good candidates for SCR must have no or minimal arthritis (joint inflammation) associated with their chronic tear. Once significant arthritis sets in, a reverse total replacement is necessary. “It’s a fairly new procedure, but my patients seem satisfied so far,” says Dr. Sasser. “Patients still need to have realistic expectations. Your shoulder’s motion won’t be exactly as it was before the tear.”
The SCR procedure is minimally invasive, requiring only four small incisions. Patients spend four to six weeks healing in a sling, then move gradually through physical therapy. Most patients feel better in three or four months, but total recovery can take up to a year.
“For so long, a chronic rotator cuff tear was one of those dead-end issues,” Dr. Sasser explains. “This can, at the very least, be a good bridge for patients. Instead of just managing their issues, you’re giving them their lives back. Some people do well with therapy and medication and, typically, we don’t jump to surgery right away. But this is a new and promising option.”
Dr. Sasser adds, “From shoulder bursitis to rotator cuff problems, we understand and deal with all levels of shoulder care. And, we’re right here in the community, working directly with physical therapists who understand the rehabilitation protocol and its equal importance for a patient’s recovery.”
For more information, call Summit Sports Medicine & Orthopaedic Surgery at 912-466-7340 or visit sghs.org/summit.