Rotator Cuff Injury Over 40: Promising Non-Surgical Treatments

Rotator Cuff Injury and Shoulder Pain

Shoulder pain caused by rotator cuff injury is a common problem, one that usually worsens over time and can impair many sports and daily activities. People over 40 tend to have more rotator cuff tendon injuries and tears, and with increased age, the healing of tendon injuries is less vigorous.

Rotator Cuff Injury And Shoulder Pain

There are many sources of shoulder pain including arthritis and bursitis, but the most common shoulder problem for many people is rotator cuff injury to the tendons. Repetitive overhead activities can lead to overuse of the tendons, and recurrent injuries tend to lead to more pronounced pain. Ultimately the accumulation of these small tendon tears can result in much larger tears.

About Rotator Cuff Injury

The rotator cuff tendons are crucial for proper rotation and stabilization of the shoulder joint. A rotator cuff injury can lead to pain with lifting, reaching, and sports including weight-lifting, golf and tennis, and may result in severe loss of movement.

The tendons of the rotator cuff all connect at different points surrounding the ball of the shoulder joint and provide strength and control of movement, which is a coordinated symphony of motion when it is functioning properly. When there is injury to any of these tendons, the motion gets out of control, the joint may catch or pop, the range of motion may be limited, and there may be pain with normal movement.

The tendons do not have to be severely torn for pain and dysfunction to occur, although a severe tear can certainly be very limiting. “Tendinopathy” refers to a lesser degree of injury, in which the fibers of the tendon become frayed, or the substance may be degenerated and have multiple partial small tears. This can occur with aging and with sports and work activities that overuse the shoulder joint. This often leads to “inhibition” of the muscles that are attached to the tendons, which became weak and are unable to generate normal force, leaving the patient feeling weakness. Tendinopathy may in many cases be as painful as a severe tear.

Rotator Cuff Injury

Treatment Options For Rotator Cuff Injury

Some patients resort to surgery for rotator cuff injury to the tendons, but that is often unnecessary and the overall recovery time for this surgery can be 6-12 months. The recovery is generally considered to be quite painful for 3-6 months after the surgery, and many months of extensive physical therapy is usually necessary to regain motion and function.

Unfortunately, the recurrence rate of significant rotator cuff tendon tears after surgical repair varies in studies from over 20% up to as high as over 60%. This means that for every 3 patients that have surgery for their torn rotator cuff, 1 or 2 patients will likely have a recurrent tear in the years afterward. Not a very encouraging outcome, given the cost, risk, and painful recovery that is typical for shoulder surgery. Repeat surgery is even more challenging, with even lower success rates and more long-term dysfunction.

Fortunately, this does not need to be a losing battle or a downward spiral. Shoulder pain with rotator cuff tendinopathy including tears seen on MRI Scans can be treated without surgery using Regenerative Medicine / Prolotherapy.

Injections of growth factors including Platelet-Rich Plasma (PRP) will stimulate repair of the damaged tendons, and the muscle – tendon unit is often restored back to normal, with long-term, essentially permanent results. The platelets in your bloodstream contain a vast assortment of growth factors which normally serve to repair your aches and pains, and these can be directly injected into the painful areas of your body to stimulate growth and repair for areas that have not fully healed through the normal processes of repair that occur every day without you even being aware of them.

When the rotator cuff tears are more severe, the use of Bone Marrow Aspirate Concentration (BMAC) can be used to improve the probability of functional recovery and tendon repair. The techniques are continuing to evolve over time, and current studies are examining the use of “scaffold” injections to provide more of a structural repair to fill the gaps within large tears, to augment the repair stimulation from PRP and BMAC.

The muscles will usually begin to turn on more normally once the tendon and the joint itself have been repaired and strengthened by a series of injections using these growth factors. Specialized exercises through Physical Therapy can then guide the muscles and tendons to once again resume the activity that they were designed to do.

Many patients will continue to have shoulder pain despite otherwise successful rotator cuff injury repair surgery. There are many structures that cause pain within the shoulder structure, and surgery frequently does not address most of these issues. The shoulder capsule, supportive ligaments, acromioclavicular joint, and other tendons will frequently be injured by the same processes that cause the rotator cuff tendon tears.

Current studies are underway to try to confirm what we commonly see clinically, which is that even after surgery, Regenerative Medicine injections using Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate can augment and strengthen the sites of surgical repair and also the majority of the other structures, in order to improve the pain and function well beyond what surgery alone can offer. With a combination of growth factor treatments using PRP, BMAC, other advanced solutions, and a well-designed exercise program, the patient can often return to golf, skiing, tennis, weight-lifting, yoga, pilates, and other normal life activities with resolution or markedly diminished shoulder pain.

Surgery is often avoidable when Regenerative Medicine injections are used by an experienced physician using the advanced tools that are now available. Even after surgery, the persistent pain that remains after surgery is often treated successfully with these advanced techniques.

David K. Harris, MD

Recent Posts

Subscribe to our Newsletter