We will see many patients after a shoulder surgery with less than hoped for results. One reason the surgery was not thought to be a success was the patient’s over-expectation of what the surgery could do and how fast they could return-to-play their favorite activity.
Researchers at the Department of Orthopaedic Surgery, Stanford University, North Shore Hospital, University of Auckland, Auckland, New Zealand; Sports Science and Medicine, Women’s Tennis Association Tour, St. Petersburg, Florida working in conjunction of a new study say:
“In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations.”
In this study, there was an over-expectation of what the surgery could do.
The arthroscopic shoulder surgery could get the player back to the game in most cases, but could not get the player back to “their” game as quickly as hoped for. In fact it took years if at all. Here are more details from this study:
During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve.
- Seven players (88%) returned to professional play.
- The mean time to return to play was 7 months after surgery.
- However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively.
- In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively.(1)
These professional players showed these results while receiving the best in rehab, training opportunities, training equipment, personal trainers, etc. What about the average patient?
Surgery was not the answer for swimmers
Researchers have documented that surgical interventions for subacromial impingement syndrome (also called Swimmer’s Shoulder, inflammation and degenerative shoulder disease from repetitive motions as in swimming), show that no technique is convincingly better than another surgical technique or that surgery is superior is any way to conservative interventions.(2)
Further, when having arthroscopic stabilization, even in youth athletes, it must be emphasized to the patients and their relatives that the recurrence rate of surgery damage and need for more surgery could be expected. Younger athletes being more vulnerable than in the adult athletes.(3)
Here again is a discussion of expectations in the athlete. While studying surgical options, no procedure showed itself better than non-surgical procedures and there is a good chance for the need of a revision surgery to repair the previous surgery.
A patient with problems of the rotator cuff or shoulder impingement may think so, however surgery is a still an invasive procedure that requires lengthy recovery and physical therapy even if successful. Further, even successful surgery has been shown to not always relieve all the pain and that shoulder weakness can remain. Complications may also include nerve damage.
In the Journal of the American Academy of Orthopaedic, surgeons offered a realistic level of expectation of surgical complication. “Most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms post-operatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge.” Your treatment options include another surgery to repair the first one. Surgery to transfer a tendon into the area, and arthroplasty.(4)
Shoulder tendon repair without surgery
The shoulder tendons are main players in rotator cuff problems, shoulder impingement, shoulder osteoarthritis and disorders of pain and weakness that get worse over time.
The symptoms of tendon weakness and injury are many and include inflammation of the tendons ( tendonitis), and/or bursitis, inflammation of the bursa (the protective sac that sits between the bones of the shoulders and allows the tendons the space they need to move.)
All would agree treating the tendons and allowing the tendons to function normally would be the optimal treatment in shoulder pain, but that is where the agreement ends. Surgeons will insist that surgery after failed conservative treatments is the way to go, other doctors are trying something else for faster results.
Stem cells and Platelet Rich Plasma Therapy are injection techniques that can accelerate the body’s own inflammatory response to repair the tendons.
By isolating the areas of the tendons that are damaged, and injecting these spots with blood platelets or stem cells, we are calling the natural injury repair mechanism of the body to the spot of deterioration. The cure is the new, controlled inflammation. This will stimulate a new collagen matrix, making the tendons stronger, thicker, and restoring them to their normal pain free state. To any athlete stronger is always the best option.
Equally, recent research suggested that bone marrow stem cell therapy showed encouraging results in pain and motion relief for patients with rotator cuff and shoulder osteoarthritis. 5
Most recently doctors in Switzerland compared PRP injections to cortisone in the shoulder. The doctors found good results for the PRP and were able to conclude that PRP injections are a good alternative to cortisone injections, especially in patients with contraindication to cortisone.5 Equally, new research suggested that bone marrow stem cell therapy showed encouraging results in pain and motion relief for patients with rotator cuff and shoulder osteoarthritis. 6
Ask Dr. Darrow about your shoulder pain
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1 Young SW, Dakic J, Stroia K, Nguyen ML, Safran MR. Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play. Clin J Sport Med. 2016 Jun 22. [Epub ahead of print]
2. Tashjian RZ. Is there evidence in favor of surgical interventions for the subacromial impingement syndrome? Clin J Sport Med. 2013 Sep;23(5):406-7. doi: 10.1097/01.jsm.0000433152.74183.53.
3.Castagna A, Delle Rose G, Borroni M, Cillis BD, Conti M, Garofalo R, Ferguson D, Portinaro N. Arthroscopic stabilization of the shoulder in adolescent athletes participating in overhead or contact sports.Arthroscopy. 2012 Mar;28(3):309-15. doi: 10.1016/j.arthro.2011.08.302. Epub 2011 Nov 30.
4. Strauss EJ, McCormack RA, Onyekwelu I, Rokito AS. Management of failed arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2012 May;20(5):301-9.
5. Lee DH, Kwack KS, Rah UW, Yoon SH. Prolotherapy for Refractory Rotator Cuff Disease: Retrospective Case-Control Study of 1-Year Follow-Up. Arch Phys Med Rehabil. 2015 Aug 5. pii: S0003-9993(15)00594-8. doi: 10.1016/j.apmr.2015.07.011.