Torn shoulder muscles repair surgery worth considering

Repairing torn shoulder muscles in elderly patients is often discouraged because of fears of complications. But a new study conducted at Rush University Medical Center has shown that minimally invasive, or arthroscopic, surgery can significantly improve pain and function.

The study has been published online in Arthroscopy: The Journal of Arthroscopic and Related Surgery and will appear in the October issue.

“In people over the age of 70, pain is the main issue, and pain relief is a fairly reliable outcome after surgery,” said orthopedic surgeon Dr Nikhil Verma, who led the study.

“Patients do not require that their shoulder function be fully restored. They just want the pain to be gone.”

With that requirement, Dr Verma said, “age is not a contraindication” for the surgery.

Tears in the rotator cuff, the complex of four muscles that stabilize the back of the shoulder joint, occur in about 20% of the population over the age of 65 and typically result from chronic degenerative changes. The tears in the musculature cause considerable pain and loss of range of motion.

Surgeons often recommend against surgery for seniors because circulation and bone quality are poorer. Many elderly patients also often have other diseases that can compromise the healing process. But the arthroscopic surgery in the cases studied proved remarkably successful.

According to the study authors, the success of the arthroscopic rotator cuff repair surgery-both objectively and subjectively-in elderly patients was due to newer surgical techniques, as well as the individuals’ commitment to post-operative rehabilitation and realistic expectations. Patients who were deemed to have irreparable rotator cuff tears were not offered arthroscopic rotator cuff repair surgery.

In other research, the American Academy of Orthopaedic Surgeons (AAOS) has approved and released an evidence-based clinical practice guideline on “The Treatment of Glenohumeral Joint Osteoarthritis.”

This major joint in the shoulder – the ball and socket joint – is sometimes affected by osteoarthritis, causing pain, loss of function, and reduced quality of life.

According to Dr Rolando Izquierdo, chair of the Academy work group on glenohumeral joint osteoarthritis, shoulder replacement surgery has been routinely performed since the 1970s for patients with advanced osteoarthritis of the shoulder. A review of the literature supports the use of both total and partial shoulder replacement for this population.

“The literature suggests, though, that pain relief is better and motion is better with total joint replacements than with partial replacements,” says Dr. Izquierdo.

“We also have to consider the 14% failure rate of partial replacements, which then require revision to total replacements. This revision is required due to progressive arthritis and pain.

The final treatment guidelines for treating glenohumeral joint osteoarthritis contain 16 recommendations. These include both operative and non-operative treatment options.