INTRODUCTION:
Welcome to the the How-to Guide for Rotator Cuff Tear Relief Without Surgery. If you want to avoid Rotator Cuff surgery, you’re in the right place! Let’s start with the basics.
Basics
The basics of Rotator Cuff tears include 4 different muscles, 1 in the front, 1 on the top and 2 in the back. The most common Rotator Cuff tear is in the top tendon, called the supraspinatus, which is a muscle that allows us to do the chicken wing motion. In general, patients have physical therapy options, corticosteroid injections like “cortisone”, or Rotator Cuff surgery. At the Centeno-Schultz Clinic, we have other options using your own body’s healing potential to avoid surgery.
What are the specific types of Rotator Cuff tears?
There are small tears that we call high-grade tendinitis, which typically lead to shoulder impingement or subacromial impingement and bursitis. These are the small tears that are created from the shoulder ball impinging the rotator cuff on the clavicle or AC joint.
The next type of tears or partial tears, almost like a frayed rope. These are still attached to bone and are very responsive to physical therapy and injections.
The next type of tear is a full-thickness retracted tear where it is ripped off bone. This is typically presents with weakness of the shoulder and decreased range of motion.
What is the difference between a Rotator Cuff tear and a Labrum tear?
The Rotator cuff is made up of the 4 muscles that help to move the ball and keep the ball seated properly into the socket. The Labrum is a fibrocartilage O ring on the socket that helps to deepen the socket. The Labrum tears are typically associated with shoulder dislocations and trauma, or repetitive shoulder subluxations with patients that have extremely loose ligaments.
Rotator Cuff Tear Surgery
Once patients fail physical therapy and/or a corticosteroid injection like cortisone, surgeons often recommend the shoulder scope to fix the Rotator Cuff. This means arthroscopic portals (holes) are made, 3 or 4 different instruments are inserted into the shoulder to increase the size of the joint with fluid removing parts of the AC joint bone, sometimes even clipping the biceps tendon, placing screws into the ball and then suturing the tendon with stitches to the screws, and then placing the shoulder in a brace for 6 weeks. Most patients have significant discomfort with this surgery along with potential risks of blood clots, infections, failure of the procedure and/or the risks of the anesthesia or nerve blocks themselves.
The recovery time can be significant, on average 9 to 12 months. The success rate is extremely variable. In a younger patient with a smaller tear, there is a higher success rate. We see approximately a 90% failure rate if the patient is above the age of 55 with Rotator Cuff tear surgery.
Alternatives to Rotator Cuff Surgery:
Activity Modification
Activity modification, is optimization of the biomechanics of the shoulder to help prevent any further impingement, or small tears from becoming large tears. This may include Egoscue biomechanical therapy, changing of activities, or certain activity modifications.
Medications
Oral medications like anti-inflammatories such as ibuprofen have short-term relief with potential side effects. There are some studies showing that turmeric can cause improvements in arthritis and joint pain with less side effects than ibuprofen.
There is no research showing that Oral steroids help shoulder rotator cuff tears. Steroid injections like cortisone can temporarily stop inflammation in the shoulder but at the same time weaken the tendon to create a full-thickness tear increasing the body’s risk for infection, decreasing overall cartilage in the joint, and even suppressing the body’s own adrenal hormones that are secreted every day.
Physical Therapy
Physical therapy options can help remove biomechanical problems, improve shoulder girdle strength and help decrease impingement along with optimizing ergonomics.
Centeno-Schultz Clinic Treatment Options
This is the last line of defense for Rotator Cuff tear relief without surgery. When activity modifications, medications and physical therapy fail, the board certified physicians at Centeno-Schultz Clinic offer alternatives to surgery with the following options:
Thorough physical examination and diagnostic musculoskeletal ultrasound along with associated areas might be contributing to the shoulder problems such as the elbow or the cervical spine. At Centeno-Schultz Clinic, our board certified physicians are experts in musculoskeletal and spine care with protocols based on our research outcomes for autologous blood platelet-rich plasma and bone marrow concentrate that includes cells to help your shoulder improve. Platelet-rich plasma has excellent outcomes for small partial rotator cuff tears.
Given some of the larger tears or full-thickness tears, bone marrow concentrate also has good outcomes evidenced by some of our publications.
We have also provided a research study enrolling patients for the bone marrow concentrate shoulder rotator cuff tear treatment and have already published the mid term analysis in a peer reviewed journal. This is available on our website to review. We had no serious adverse events or complications, and we had successful treatment options and functional return in our patients.
Another option is the bone marrow concentrate culture expansion procedure that the board certified physicians at Centeno-Schultz Clinic are able to perform at our Grand Cayman licensed medical clinic.
CONCLUSION
Rotator Cuff tears can be life-altering and debilitating to patients. At Centeno-Schultz Clinic, we were able to offer alternatives to surgery, avoid the lengthy rehabilitation and avoid potential complications of surgery with ultrasound and x-ray guided injections of patients own Platelets and Bone Marrow Concentrate to stimulate the body’s own healing response. This is typically the best option for the majority of patients that fall in between shoulder replacement and simple physical therapy and cortisone injections. All patients receive a physician one on one consultation for an extended length of time with a musculoskeletal ultrasound as well as all x-rays, CT scan and MRI imaging review to determine the best treatment for you. After our consultation, all patients will receive a Candidacy grading and a very clear treatment plan on the next steps to treatment, and rehabilitation exercises thereafter. Please contact us if Rotator Cuff surgery has been recommended or you have a friend or family member that has had Rotator Cuff surgery recommended, for a second opinion.
References
- Centeno C, Fausel Z, Stemper I, Azuike U, Dodson E. A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis. Stem Cells Int. 2020 Jan 30;2020:5962354. doi: 10.1155/2020/5962354. PMID: 32399045; PMCID: PMC7204132.
2. Centeno CJ, Al-Sayegh H, Bashir J, Goodyear S, Freeman MD. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015 Jun 5;8:269-76. doi: 10.2147/JPR.S80872. PMID: 26089699; PMCID: PMC4463777.
