[S2E2] Small Tears
Many people have very successful surgeries for partial rotator cuff tears. In our office, we usually do not see these people. We see the people who did not have a good surgical outcome in the past or had a very successful outcome in the past but the patient did not want to go through the extensive rehabilitation.
The concern about surgery for partial rotator cuff tears is that you may be operating on something that is not even there. This is not solely our opinion, there are many studies confirming that an MRI may send you to unnecessary shoulder surgery.
The outcome of this paper was a suggestion to primary care physicians that they use ultrasound as the initial test in younger patients and in patients with suspected full supraspinatus tears, based on clinical exam, with MRI as an option for further evaluation to quantify supraspinatus muscle atrophy.
A February 2022 study in the journal Arthroscopy (25) found ultrasound outperformed MRI in diagnosing partial-thickness subscapularis tear. In this study, a comparison between ultrasound diagnosis and MRI diagnosis was made by confirming these imaging readings against what doctors found during an arthroscopic procedure. The significance of this study is that of 437 patients who were scheduled to undergo arthroscopic rotator cuff repair, preoperative ultrasound and MRI of the shoulder were performed, and ultrasound correctly diagnosed 122 of 157 patients with subscapularis (SSC) tears, with an overall sensitivity of 77.7% which was significantly greater than that of MRI.
Doctors at Tohoku University School of Medicine writing in the American Journal of Sports Medicine (6) were looking for the risk factors for tear progression in painful rotator cuff tears when a patient decides not to have the surgery. These researchers also looked at the type of patient, high active, and low active, in determining an accurate assessment.
Patients with either a high-grade partial-thickness or small-to-medium-sized full-thickness tear were included in this study. The primary outcome measurements to see which patients did well or did not do well were a pain assessment score and range of motion score one year after treatment.
Articular-sided partial-thickness rotator cuff tear by itself did not cause shoulder pain and muscle weakness in university baseball players. Most so-called articular-sided partial-thickness rotator cuff tears may not be pathologic tendon tears.
Shoulder instability increases the force on rotator cuff tendons. The rotator cuff is designed to move the shoulder joint, not stabilize it. This causes the tendons to weaken and degenerate, increasing susceptibility to tearing. Rotator cuff tears are indicative of joint instability. Traditional treatment for shoulder instability is rotator cuff strengthening exercises, specifically of the supraspinatus muscle, the primary muscle responsible for the external rotation of the shoulder. A rotator cuff is a group of four muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The rotator cuff muscles help stabilize the shoulder and assist with movement. Rotator cuff strengthening exercises help strengthen shoulder muscles but often do not cure the underlying problem of shoulder instability. To fix shoulder joint instability, the shoulder ligaments and shoulder capsular structures must be strengthened.
Danielle Matias, PA-C gives a general overview of when Comprehensive Prolotherapy with PRP is used for rotator cuff or other shoulder tears and shoulder instability cases and compares this to when a patient is typically referred for surgery.
An April 2022 paper in the Journal of Sport Rehabilitation (26) assessed the effectiveness of Ultrasound-Guided corticosteroid injections, Prolotherapy, and exercise therapy on partial-thickness supraspinatus tears.
A hip labral tear is a common injury that may cause hip and groin pain as well as other symptoms, such as hip locking or instability, depending on the severity and locat