Getting the Right Treatment: The Present and Future of Rotator Cuff Repair

Women helping out her mother

Women helping out her mother

This is the last post in a series about rotator cuff injuries in patients over 40.

Life spans have nearly doubled over the past 100 years as a result of medical advances. Unfortunately, our muscular-skeletal systems haven’t kept pace, according to Dr. Peter Sallay, an orthopedic physician who specializes in shoulder reconstruction at IU Health's partner, Methodist Sports Medicine.

In patients over 40, rotator cuff tears are a common muscular-skeletal injury with long-term health implications. Sallay says even a minor tear can eventually become a bigger health issue as patients age. That’s because tears sometimes increase in size with normal wear, hindering mobility and self-care at an advanced age.

Treatment options vary based on age and activity level
Whenever possible, doctors prefer to treat rotator cuff injuries with non-surgical techniques like physical therapy and injections. Once the tendon is torn, it doesn’t heal on its own. But physical therapy can improve the function of other muscles, compensating for the tendon that doesn’t work.

Most surgical solutions today are done arthroscopically for less post-surgical pain, fewer complications and better cosmetic results. For severe cases in older patients, there is a new type of joint replacement called reverse shoulder arthroplasty. The name stems from the fact that the replacement ball is positioned where the socket would be and vice versa. This changes the center of rotation, allowing the joint to rely on the deltoid muscle to move the arm.

“The geometry of this design is such that the replacement works without help from the rotator cuff.” Unfortunately, it’s not an option for younger patients because the replacement parts aren’t durable enough. Even in older patients, Sallay says this is usually a last resort because of possible complications.

The future of healing rotator cuff injuries
The next big thing in rotator cuff treatment, Sallay says, will be human growth factors, the body's natural chemicals that aid healing. “This is one of the big pushes in medical research today,” he explains. “Researchers will figure out which factors heal tendons. We’ll learn how to apply this research to leverage healing, not just for tendons, but for the whole body.”

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