His questions to me, followed by my responses:
a) have you had significant experience with tears that are this large ?
YES!!
See this link:
http://www.rearmyourself.com/article...tor-cuff-tears
b) were their any unsuccessful outcomes in (a) and why ?
YES—re-tears can occur due to poor compliance (use of a sling with no motion for 6 weeks) or due to poor tissue quality. But in younger pts I have had good success.
c) what is likelihood that this tear is getting worse presently - pain / other ?
Increasing pain is the best litmus test for this: see this link:
http://www.rearmyourself.com/questio...he%20downsides
d) am I ok with keeping the shoulder very active as discussed above as long as I don’t put stress on the supra and infra ? Is supra and infra ROM ok even with light resistance ?
YES to both---
e) how critical is it that I get this completed sooner with respect to tissue quality and overall repairability, etc ?
No way to know for sure---but sooner is better than delayed to prevent further atrophy and retraction.
f) Are there instances where you start a "arthroscopic surgery" and then do a "open" because of complications or initial size of tear ?
No—never had to in the last 8 years!!
g) is their a “worst case scenario” that you would do if the existing tendon quality is poor ? Would you take a tendon from elsewhere to support the structure ? It seems to me that until anyone puts a scope inside the joint any definitive answer is very subject - true ? ...obviously I would prefer a "arthro" vs. a "open".
If the tear in not fixable, at your age, with your function, I would probably not advise an open surgery---certainly not right away. If you started to lose function you might be a candidate for a latissimus transfer. See this link:
http://www.rearmyourself.com/article...tor-cuff-tears
However, once you hit your mid sixties, were function to decline, and pain to increase, I would lean more towards a reverse shoulder. No question that the 1st step is an arthroscopic procedure.
h) how many of your surgeries have lead to "open" procedures ? how traumatic is a open procedure on the deltoid ? Also I read that the subscapularis is to some degree compromised ? My subscap is excellent given physical testing.
Again—I would not perform any open surgery—it is never needed.
i) do you use any innovative inputs to aid in healing such as - blood spinning or patches in the compromised areas effected ?
I do not---These “biologic” interventions have “theoretical” merit, but there is no true evidence in the literature to support; as a result, insurance precludes trying them.