Many Rotator Cuff Surgeries May Be Unnecessary
/By Pat Anson
Since I write about chronic pain and the many different treatments for it, it’s not uncommon for readers to ask if I’ve ever experienced it myself.
The answer, unfortunately, is yes.
About 15 years ago, I started feeling a dull pain in my left shoulder that wouldn’t go away. It progressively grew worse, and my arm became so painful to move that I had trouble putting on a shirt or sleeping in the same position for more than a few hours.
Only then did I finally see a doctor. An MRI confirmed there was a “wrinkle” in my rotator cuff, and that the ligaments, muscles and tissue in my shoulder were inflamed. I had adhesive capsulitis, also known as a “frozen shoulder.”
The doctor gave me a cortisone shot and prescription strength ibuprofen, and when neither of them helped, he recommended rotator cuff surgery or physical therapy. I opted for the latter.
Everyone thinks their lived experience with pain is unique, and I’m no different. But it turns out my experience with shoulder pain is all too common and is likely a normal part of aging.
According to a new study in JAMA Internal Medicine, almost everyone over the age of 40 will experience a rotator cuff injury.
Using MRI images, researchers in Finland studied the shoulders of over 600 people between the ages of 41 and 76. Although only 1 in 6 had complaints of shoulder pain, virtually everyone had a rotator cuff injury of some kind, ranging from a full tendon tear to age-related joint damage.
The findings challenge the value of advanced imaging like MRIs, which may be diagnosing shoulder problems that don’t need fixing — or at least don’t need to be treated with invasive injections and surgeries.
“In this population-based study, RC (rotator cuff) abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms,” wrote lead author Thomas Ibounig, MD, an Orthopaedic Surgeon at Helsinki University Central Hospital.
“These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain.”
Ibounig and his colleagues found that many people can have inflamed tendons (tendinopathy), full tendon tears (FTTs) and partial tendon tears (PTTs) in their shoulders without experiencing pain or any other symptoms. Only when they get medical imaging are the rotator cuff abnormalities found, which sets in motion a process that can lead to invasive treatments.
About half a million rotator cuff repairs are performed annually in the United States, with the surgeries increasing at a rate of about 2% a year for patients 50-64 years of age. Their success rate is mixed, from about 90% for PTTs to as low as 50% for FTTs. Full recovery from rotator cuff surgery may take several months to a year.
The Finnish study suggests that many of those surgeries are unnecessary and that shoulder pain should be accepted as a normal part of aging.
“Given that tendinopathy, PTTs, and even FTTs may be incidental findings, clinicians should consider their high population prevalence when interpreting imaging results and deciding on interventions targeting these abnormalities. Reframing many of these findings as normal age-related changes rather than disease may help guide more appropriate care and reduce unnecessary interventions,” they concluded.
It took several months of physical therapy before my shoulder pain subsided. It still aches occasionally, but I no longer have the sharp stabbing pain that I used to get. And it’s no longer chronic.
I still use the stretches and exercises that I learned during physical therapy to keep my left shoulder from “freezing” again. It’s a good thing I learned how to do them, because now my right shoulder aches too.
