Dr Michell Ruiz

Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador

sábado, 21 de septiembre de 2013

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tear, when to repair and when not to ...

Rotator cuff tear, when to repair and when not to repair


Our post yesterday on the AAOS 'appropriate use criteria' for rotator cuff tears has given rise to some thoughtful responses, such as "I read your blog every week. As a shoulder surgeon and app developer, I think AAOS had a nice idea. Of course our decision is made by our experience, but this can be a tool to encourage people to perform/not perform surgery. Like instability index, it will not substitute our judgment, but was a nice constructed tool. "

We thought about this a bit, appreciating the feedback given. We continue to opine that the AAOS AUC app is oversimplified and can be used to encourage surgery by some gentle 'tweeking' of the responses without consideration of the full picture.

Keeping in mind that 'repair' is not the only surgery that can be offered to a patient with a bothersome cuff tear, see here, there are two questions that need to be considered before embarking on REPAIR surgery:
(1) can the cuff tear be durably repaired?
 and 
(2) is it in the best interests of the patient to have a repair recognizing the need to protect the shoulder from normal use for 3-6 months after surgery, in other words, are the improvement in comfort and function from an attempted repair likely to be sufficiently superior to that of non-operative management or a 'smooth and move' to justify the time away from work and play? While some justify a repair attempt by noting that patients are 'better' even if the rotator cuff repair fails to reattach the tendon to the bone, the key difference between a repair and a smooth and move is the need for protecting the armfor months in the former.

Below are listed findings that have been shown to be encouraging or discouraging about the prospect of the shoulder having a durably reparable cuff tear. It is of interest that many of these factors can be determined without advanced testing. We first published these guidelines in 1994 and have found them as useful to day as back then. Note that the decision is not based on choosing one of two bubbles in an app, but in considering the patient as well as the shoulder (two of the 4Ps the other two are, of course, who should do the surgery and how it should be done).
Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tear, when to repair and when not to ...: Our post yesterday on the AAOS 'appropriate use criteria' for rotator cuff tears has given rise to some thoughtful responses, such ...

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