Joint Preservation Blog

August 28, 2008

Rotator Cuff Surgery

Thinking about rotator cuff surgery? What’s done and why? How invasive is this? What’s a doctor’s perspective? Rotator cuff surgery usually involves stiching back together the torn ends of the rotator cuff tendon(s) or muscle(s). This means that the surgeon will open an arthroscopic port and place an arthroscope about the size of a ball point pen into the shoulder joint cavity. Under direct visualization, the torn ends will be brought back together and the repair stitched. Sounds simple? Not so fast. The immobilization needed to allow the stitches to mend the tissue also can cause major atrophy of the rotator cuff muscles (read muscle shrinkage). This is why as doctors, we often see patients after these surgeries who have lost function and don’t seem to return to high level activities. Sure they can use the arm again, but it’s never quite the same.

Is there another way? One of the problems with even a small tear is that the blood supply and resources to heal it are often inadequate. What if you could supply building blocks to aide normal healing and increase the blood supply. One candidate for this is mesenchymal stem cells. These are adult stem cells that can turn into (differentiate into) muscle and tendon cells. They also help orchestrate a repair response by bringing in new blood supply to the area. While this may sound like science fiction, it’s already being done. The Center for Regenerative Medicine will harvest these cells, grow them to bigger numbers in culture, and inject them back into the tear. While large, full thickness tears may not be a candidate for this type of injection based treatment, patients with partial tears are good candidates to avoid rotator cuff surgery.

So how do you avoid the pitfalls of rotator cuff surgery? Just skip the surgery part!

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