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Degenerative rotator cuff tears are very common. Many small degenerative rotator cuff tears will not require surgery. After 40, many people will have a rotator cuff tear and not even know it. You may wish to review our first Expert Series post where we covered the cause of rotator cuff tears.

Remember:

The rotator cuff is the most likely source of pain after 30
Most rotator cuff issues, including tears are due to degeneration or attrition
Most patients with small degenerative rotator cuff tears can be treated without surgery.
Surgery for degenerative rotator cuff tears is generally considered after failure of a non-surgical regimen of physical therapy, possible injections and oral medications.

As accomplished shoulder surgeons, when do we consider surgery for a small degenerative rotator cuff tear?

Our Expert Series continues today with an answer to your question:

Do I Need Rotator Cuff Surgery ?
Derek Ochiai, MD: Website, Twitter

Surgery is an option for degenerative rotator cuff tears that fail to respond adequately to non-surgical treatment, such as physical therapy and cortisone injections. Also, the rotator cuff tear is inhibiting the patient’s quality of life.

Scott Slattery, MD: Website, Twitter

There are many options for the treatment of a small degenerative rotator cuff tear. I give all patients with small degenerative tears the option to treat them non-surgically with anti-inflammatory medications as well as physical therapy to improve flexibility, strength, muscle balance and coordination. This can work quite well. If the patient has good function and minimal pain, surgery is not absolutely required. If the tear is degenerative, chronic and large with associated muscle atrophy, initial non-surgical treatment with oral medications, injections and physical therapy is almost always the best option.

Marty Leland, MD: Website, Twitter, Facebook

When I first see a patient over 40 with shoulder pain, my first treatment is anti-inflammatories, physical therapy, and frequently a subacromial steroid injection. I will then see the patients back 6-8 weeks later. If they are much better, there is no need for any further treatment. If they aren’t much better, I get an MRI to evaluate their rotator cuff. I usually do not order an MRI the first time I see them because, even if they do have a small rotator cuff tear, I would like to see if non-operative treatment would help them. If it does, GREAT! They may have avoided a surgery. I only order MRIs if they aren’t getting better. However, if I have a patient with a long history of shoulder pain and weakness and they are very weak on examination, I sometimes do order an MRI after the first office visit.

Jeffery Berg, MD: Website, Twitter

Degenerative rotator cuff tears are extremely common. Often these tears can be asymptomatic and incidentally diagnosed. So the first component of my “treatment” for these tears is to determine if they are symptomatic or not. If not felt to be symptomatic, I direct my treatment towards the suspected source of the patient’s symptoms and I advise observation of the tear. The observation primarily consists of clinical evaluations (history and exam) yearly if they remain asymptomatic or sooner if symptoms worsen, since these tears can progress and that progression usually is associated with an increase in symptoms. Depending on the office evaluation, I might also suggest serial ultrasounds or MRIs to evaluate for progression.

If these tears are felt to be symptomatic, I typically will start with nonoperative treatment. I find this to be the most reasonable treatment as degenerative tears often respond favorably to “conservative care” and although the symptoms can often respond well to surgery, they often don’t fully heal following the surgery. My nonoperative treatment consists of oral anti-inflammatories to treat the frequently associated bursitis as well as the pain that often brings the patient to the office. I will almost always include physical therapy as there usually is associated shoulder dysfunction and finally I suggest avoiding aggravating activities. Typically, I try this for 4-6 weeks, looking for any improvement. If improvement is seen, I will suggest continued nonoperative treatment until symptoms resolve or stabilize at an unacceptable level. If the latter, I will recommend an arthroscopic repair. If there is some retraction (lateral to mid humeral head) seen on the MRI, and depending on some specific patient characteristics (ie. young health, high activity level, etc.), I may suggest surgery on initial diagnosis, as I am concerned that if there is any further retraction, the tear may become unrepairable.

How we as physicians manage certain injuries may not always seem logical to patients. Many will not understand why we do not MRI every painful joint and many do not understand why we do not need to operate on everything that is “torn”. It is our obligation to educate you.

Our last post … When Should We MRI Your Shoulder will help you understand that we can make a reasonably good diagnosis and establish a treatment plan that should work without expensive, time consuming imaging. In addition, many of our parts wear out. Like your favorite pair of jeans … Not all rotator cuff tears need to be fixed. The American Academy of Orthopedic Surgeons produced a document to assist surgeons in evidence based management of rotator cuff tears. In this document, they find limited evidence to support surgery for degenerative rotator cuff tears without a trial of non-surgical management. That said, some rotator cuff tears might continue to hurt after non-surgical treatments … and you might be offered surgery as an option to improve your pain and thus your quality of life.

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AxiaLIF® means Axial Lumbar Interbody Fusion. It is an alternative to traditional open and minimally invasive low back surgery performed to treat degenerative disc disease (DDD), spinal stenosis, or low grade spondylolisthesis at L5-S1.

In some patients, these disorders may lead to spinal instability and pain. The procedure involves implanting the AxiaLIF device (a short threaded rod) after the center of the disc is removed from between the last lumbar vertebra and the sacrum (L5-S1).

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Disc problems can start from over-use, an accident, or just the wear and tear of daily life. Degenerative changes in the discs may result in damage that can cause pain.
When a disc degenerates it can have tears or cracks that lose water, which cause it to become thinner and provide less padding to absorb movement.
Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands.

The post What is Degenerative Discs? appeared first on Dr. James Manzanares.

Spinal decompression is a type of surgery to relieve symptoms caused by pressure on the spinal cord and/or the nerves branching off from it. Pressure (compression) on the nerves or spinal cord can be the result of several factors including:

Bulging or herniated discs
Bony growths
Loosened ligaments.

Symptoms of spinal nerve compression in the low back include:

Pain in the low back, as well as in the buttocks and down the leg
Numbness or tingling in the buttocks, leg and foot
Weakness

The post What is Spinal Decompression Surgery? appeared first on Dr. James Manzanares.

• Come with you to doctor appointments.
• Stay with you in the hospital.
• Ask questions of healthcare professionals.
• Review consent forms for treatment.
• Remember healthcare instructions for you.
• Know what to look for and who to call should your condition get worse.
• Speak up for you if you cannot.
• Know your wishes regarding resuscitation and life support.

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• Seek information about illnesses or conditions that affect you, options and possible treatment plans. Good sources of information include your doctor, libraries, medical society websites, and support groups.
• Ask questions of your doctor, nurse, pharmacist and other healthcare professionals, and choose a doctor, clinic, pharmacy and hospital experienced in the type of care you require.
• Take notes when you talk with your doctor and ask him or her for written information.
• Thoroughly read all medical forms and make sure you understand everything before you sign.
• Become familiar with how to operate equipment used in your care.
• Never be afraid to seek more than one opinion. It is not an insult to your doctor. If you are unsure about the nature of your illness or the best treatment, consult one or two more specialists. Getting more information lets you be more confident in your decisions.

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Work with your doctor and other healthcare professionals, and participate in all decisions about your treatment.

• Keep records about your medical history and share up-to-date details with your healthcare team. Your medical history includes:
  • Any medical conditions and illnesses
  • Immunizations
  • Allergies, reactions and sensitivities
  • Past hospitalizations
  • Other doctors treating you
  • Medications and dietary supplements (i.e., vitamins, herbal products).
• You and your doctor should agree about exactly what will be done during each step of your care.
• Know who will take care of you, how long treatment will last, and how you should feel.
• Ask to speak with other people who have undergone a procedure you are considering. They can help you prepare for what to expect and the best ways to recover.

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