Rotator Cuff Repair Cementless Shoulder Journey

[Cementless]

I think I might have a torn rotator cuff. I will have an MRI on Oct. 1, 2021.
I have pain every day. I take ES Tylenol and ice it but it only helps a little while.
I hear the surgery is terrible and worse than a shoulder replacement. I might need a shoulder replacement too but have osteoporosis. I'm not sure I can handle a shoulder replacement.

 

[SaraK]

@Cementless - I'm going to ask the mods to move your post to a separate per preop thread for you. That will make it easier for us to address your questions.

When they assessed my rotator cuff MRI, they also looked at the state of the joint itself to decide whether to do a replacement or just the repair. In my case, the joint was good so we proceeded with a repair.

I had so many well meaning people tell me a rotator cuff repair was the worst surgery from a pain standpoint. The recovery was slower than with my hip replacement - especially since I couldn't do much with that arm for 6 weeks and then had to build back slowly. From a pain standpoint, though, the severe pain didn't last nearly as long as with the hip replacement. I took less meds for a shorter period.

So don't let others make you hesitate!

 

[Jockette]

Hi, @Cementless I‘m sorry you're having shoulder issues. As you know, this is the best place to get information and make a plan. We’re here for you!

As SaraK suggested, I started a pre op thread for you. Best Wishes.

 

[Cementless]

Has anyone tried stem cells for their shoulder pain?

 

[Jaycey]

@Cementless I am afraid stem cell therapies only work if there are little or no symptoms. Used very early on they may work. But in most cases they patients are too far into an injury or deterioration to benefit from stem cell therapy.

 

[Cementless]

What about this: An ultrasound is done by the physician to locate the actual place of injury. The PRP is then injected into the site of injury to reduce pain and promote healing. PRP therapy uses the patient’s own blood so the treatment is associated with minimal risk factors or contraindications.
Anyone tried this?

How We Create PRP
With PRP, we draw some blood in the office, just like having a standard blood test. Then, while you wait, we process your blood to extract and concentrate the platelets. We then inject the platelet concentrate directly in the damaged area(s). The platelets release their growth factors and the healing begins.

Because it uses your own blood, PRP is very safe. Conditions that can be treated effectively with PRP include: Rotator Cuff damage, Tennis & Golfer’s Elbow, Achilles Tendonitis & Plantar Fasciitis, joint pain, arthritis, neck, and back pain (including disc problems), and most sprains and strains.

How PRP Therapy
Can Help You
PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:

• Rotator cuff injuries, including partial-thickness and full-thickness tears
• Shoulder pain and instability

 

[Jamie]

This procedure is fairly expensive and it won't be covered by your insurance. Success is kind of hit and miss with PRP replacement, so you need to be prepared that it would not help you, even though the information you've presented, I'm assuming came from a clinic's website that performs these procedures, makes it sound like it can improve any problems.

It's true that rotator cuff repair surgery can be more difficult to recover from than an shoulder replacement. I think it would be a good idea to wait and see the results of your October 1 imaging and go from there. If a shoulder replacement is needed, with a torn rotator cuff it would be a reverse shoulder replacement which is usually fairly easy to recover from.

 

[Jockette]

Please post the link to the above information about PRP. Thanks!

 

[Cementless]

broken link removed: https://www.inov8ortho.com/platelet-rich-plasma-prp-inov8-orthopedics.html

 

[Cementless]

Shoulder MRI Results from yesterday:

BONES
* No fracture is identified.

IMPRESSION:

1. LEFT rotator cuff:
* Supraspinatus/Infraspinatus: Mild undersurface tendinosis is seen about the distal critical zone and footplate of the supraspinatus and infraspinatus without a discrete tear identified.
* Subscapularis: Intact.
* There is no significant fatty streaking or loss of the muscle bulk.

2. Moderate acromioclavicular osteoarthritis with evidence suggesting active inflammation.

3. The labrum appears intact.

4. Low-grade glenohumeral chondromalacia about the anteroinferior quadrant.

I might be a candidate for the PRP, maybe stem cells or for sure a cortisone injection. I have an appointment with the shoulder ortho this coming Friday at 1 pm. It kinda bothers me that he is just an DO. Are there any draw back to getting cortisone shots? I don't want it to add to my osteoporosis!

 

[Jamie]

Thanks for posting your MRI results. It's great news that you don't seem to have any rotator cuff tears and your shoulder problems are in the early stages of degeneration.

There is nothing wrong with seeing a DO, so dont worry about that. A better thing to consider is how many cases like yours has this doctor treated successfully and what outcome he predicts for you with whatever treatment he recommends. Many times people may benefit from targeted physical therapy. Cortisone injections may give some temporary pain relief, but they can cause tendon damage in some cases.

I suggest you write out some questions for your upcoming appointment and make no decision quite yet about your treatment.

I would schedule a second opinion consultation (provide the results of your MRI) with Dr. Theodore Shybut at Baylor College of Medicine Medical Center. He does all the same procedures your current doctors do plus he has been using an innovative product from Rotation Medical, a bioinductive patch that is attached over the tendon in an arthroscopic procedure. It's quite interesting, in that the patch induces the degenerating tendon tissue to regrow and eventually the patch is incorporated into the tendon so that it heals. You can find a detailed explanation of this at Dr. Harward Luks's website (he's in New York) so you'll know a little bit about the procedure when you talk with Dr. Shybut to see if this is something appropriate for your situation.

Let us know how things go for you and I do hope you'll seek out this second opinion so that you have as much information as possible before making a final decision.

 

[Cementless]

Cortisone injections may give some temporary pain relief, but they can cause tendon damage in some cases.

I suggest you write out some questions for your upcoming appointment and make no decision quite yet about your treatment.

I would schedule a second opinion consultation (provide the results of your MRI) with Dr. Theodore Shybut at Baylor College of Medicine Medical Center. He does all the same procedures your current doctors do plus he has been using an innovative product from Rotation Medical, a bioinductive patch that is attached over the tendon in an arthroscopic procedure. It's quite interesting, in that the patch induces the degenerating tendon tissue to regrow and eventually the patch is incorporated into the tendon so that it heals. You can find a detailed explanation of this at Dr. Harward Luks's website (he's in New York) so you'll know a little bit about the procedure when you talk with Dr. Shybut to see if this is something appropriate for your situation.

@Jamie: I understand that cortisone injections may give temporary pain relief. About 20 years ago, I had severe plantar fasciitis and the podiatrist I saw gave me 2 cortisone injections, maybe a year apart. The second time he did it, he ruptured my plantar fascia!!! I was in a boot for a couple of months!!!

I still like the idea of the PRP. It sounds less invasive than the patch. The patch is something to consider though. I will discuss it with this DO. He is in the same group of doctors that did my Left knee revision which I still have some issues with (but tolerable). I'm still leaning toward the cortisone injection on Friday to at least reduce the inflammation. I am lucky that I have very good range of motion.
Thanks you for such great information!

 

[Jamie]

The surgeon I recommended to you does PRP as well. That's why I recommended him - because he may be able to suggest a wider range of options than your current surgeon. Nothing wrong with talking about the patch procedure with your current surgeon, but if he's not experienced in that procedure, I wouldn't suggest you consider having him do it. It never hurts to have a second opinion, even if you still stay with your current doctor. I was quite surprised to find a surgeon near you who did the bioinductive patch.

 

[Cementless]

I was quite surprised to find a surgeon near you who did the bioinductive patch.

@Jamie: Do you know anyone that has had the "bioinductive patch"? If so, How did they do?

 

[Jamie]

No, I don't. The procedure was new to me and I only discovered it when doing some research after reading your MRI report. I was reading about it on Dr. Luks's website. He is a surgeon I know of and trust for information, but he's in New York....not near you. He mentioned Dr. Shybut as a resource in Houston.

 

[Cementless]

@Jamie: I wonder how the OS secures the "bioinductive patch"? If it is glue....I am VERY allergic to glue products! The picture almost looks like staples. I couldn't find information on that. Any idea?
From what I read about Dr. Shybut, I am impressed.

I did see a video that said they use staples that dissolve over time.

 

[Cementless]

@Jamie, I did call Dr. Shybut's office. He only does the "bioinductive" patch if there is a rotator cuff tear.
Not for tendinosis (preventive for a tear).

 

[Jamie]

Rats. But thanks for the information. Sorry that idea didn't work out.

 

[Cementless]

I had a cortisone shot in my left shoulder today and I already think it is helping. I really like the doctor, even though he is a DO. He said I have tendonitis. Also, a bone spur that is irritating my rotator cuff. Osteoarthritis is moderate. He thinks the cortisone shot is all I need plus gave me some PT exercises to do. In the future if my shoulder continues to bother me, he said they could go in there and do arthroscopic surgery to clean the joint up and remove the bone spur that is pressing on the rotator cuff.

I ask him about Glucosamine Chondroitin and he seemed to really like it. Suggested Cosamin from Amazon but said it is something you would need to take for the rest of your life, can't stop and start it.
Anybody here taking Glucosamine Chondroitin? Any side effects?

He had heard of the "bioinductive" patch but said, it is used if the surgery to repair the rotator cuff doesn't work (?). Also, Rotator cuff surgery IS more painful than shoulder replacement surgery. People have to be in a sling for a least 6 months.

 

[Jamie]

I've heard the same about recovery from rotator cuff repair. Shoulder replacement must be a breeze compared to that recovery. I'm glad this is working for you and that you like this doctor. Years ago when my shoulder was really bad, I was able to get several more years out of it with a cortisone shot and an arthroscopic cleanup. Thankfully my rotator cuff remained healthy so that I was able to then get a standard shoulder replacement. I don't know if waiting is always a good idea. In my case I was caring for my husband and couldn't do that and shoulder recovery at the same time. However, my shoulder was "trashed" (medical terminology used by my surgeon ) and I needed to do something to try and delay the surgery.