That having been said, arthroscopic assessment may reveal that repair is possible, even if just a portion of the cuff. In that regard-- there exists growing clinical evidence that muscle denervation may be reversible after repair (partial or complete) of chronic tears because of a beneficial effect on the suprascapular nerve.
In my experience with 16 massive repairs between 2002 and 2005, I have come to believe that there is no role for saying: "I am sorry--you have an irreparable tear." In fact, surgical techniques may allow for at least a partial repair, which truly can improve function. Further, if repair is not possible, biceps tenotomy with possible release of the Suprascapular nerve may help to decrease pain and improve function.
Postoperative rehabilitation begins after 6 weeks of strict immobilization in a sling. Passive motion takes place from 6 until 12 weeks. Active motion starts at 3 months, and full recovery may take 12-18 months.
I have attached a review article by Dr Gerber below, which outlines treatment options. I have experience with each of these options and agree with Dr Gerber's philosophy and points.
2 comments
MDSBigPaPa 3/24/11 at 6:34 pm
Dr. Tomanio I look forward to meeting with you. I have full thickness tears of the supraspinatus, infraspinatus and subscapularis with approx 4 cm retraction of the supraspinatuis of the right shoulder. I also have a ruptured biceps that's over 10 years old on the same shoulder. Current diagnosis is it's inoperable - two orthopedic surgeons concur. My first priority, however, is getting my left shoulder in good working order such that I can have a little pain relief ,,,
mtomaino 3/27/11 at 12:41 pm
I look forward to seeing you. While your tears may indeed be irreparable--such conclusions are typically "inferences" made on the basis of MRI and plain x-rays. For example, the MRI may not only show retraction, but also muscle atrophy; and the plain film may show that the humeral head has migrated proximally. Both of these findings are typically consistent with chronic tears, as well as lower healing potential if repair is indeed possible. In my experence, about 30% of the massive tears that i have been able to repair were considered "irreparable" by others.
Any decision to scope your shoulder will be predicated on a number of factors including your degree of pain, functional impairment, and whether other options are more likely to meet your expecations, such as reverse shoulder replacement. I look forward to meeting with you to discuss.
I HAVE ATTACHED A RECENT ARTICLE THAT ADDRESSES THE VARIOUS TREATMENT OPTIONS FOR MASSIVE TEARS. DR GERBER IS REGARDED AS ONE OF THE FORMOST AUTHORITIES ON THIS SUBJECT.