Is rotator cuff repair worthwhile in patients with co-morbidities?

Yash Kishore Shah, Rohan Kiran Khavte, Parag Kishore Munshi

Abstract


Background: Rotator cuff tears are a common source of shoulder pain. The incidence increases with age and is most frequently due to degeneration of the tendon, rather than injury. This study is done to see whether in patients having established rotator cuff tears with co-morbidities like hypertension diabetes, epilepsy, etc. a surgical repair is worthwhile or whether it is better to leave such patients alone in order to give them a better quality of life.

Methods: A total of 35 patients with co-morbidities, treated by a single surgeon of which 8 by open method, 19 with arthroscopic assisted mini open rotator cuff repair and 8 entire arthroscopically were evaluated retrospectively. Small tears (<1 cm), medium tears (1-3 cm); large tears (3-5 cm) were addressed by the same surgical procedure using bone tunnels, suture anchors, or a combination of both. The patients were evaluated by history, examination, pain scores and constant scores.

Results: As compared to patients with no co-morbidities, these patients took longer time for healing especially diabetics. Despite that 27 patients had excellent pain relief, 5 good and 3 poor pain relief. Constant scores improved in all patients.

Conclusion: Patients with co-morbidities take longer time to heal, yet the final outcome which is attained and relief of pain and relief in the form of activities of daily living that we could offer the patients makes the surgery worthwhile. It is well worth operating on patients with co-morbidities and a rotator cuff tear, giving them a better pain free life and better activities of daily living.

 


Keywords


Rotator cuff, Cuff tear, Shoulder arthroscopy

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References


Calis M, Akgun K, Birtane M, Karacan I, Calis H, Tuzun F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59:44-7.

MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg. 2000;9:299-301.

Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;173:70-7.

Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8:151-8.

Calis M, Akgun K, Birtane M, Karacan I, Calis H, Tuzun F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59:44-7.

Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle: clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389-94.

Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.

Constant CR. Assessment of the shoulder. In: Watson M, eds. Surgical disorders of the shoulder. 2nd ed. New York: Churchill Livingstone; 1991: 39-45.

Constant CR. Constant scoring technique for shoulder function. SECEC information. 1991. Nr 3. Available at: www.secec.org.

Gerber C. Integrated Scoring Systems for the Functional Assessment of the Shoulder. In: Matsen F, Fu F, Hawkins R, eds. The Shoulder: a Balance of Mobility and Stability. 3rd ed. Rosemont: American Academy of Orthopaedic Surgeons; 1992: 531-550.

Scoring Systems for the Shoulder. Circular to members of British shoulder and elbow society, 1997. Available at: http://www.axelina.com/ENG/kvalitet/kva_score.htm. Accessed 5 November 2007

Clark JM, Harryman DT. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74:713-25.

Ruotolo C, Nottage WM. Surgical and non-surgical management of rotator cuff tears. Arthroscopy. 2002;18(5):527-31.

Templehoff S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296-9.

Zaslav KR. Internal rotation resistance strength test: a new diagnostic test to differentiate intraarticular pathology from outlet (Neer) impingement syndrome in the shoulder. J Shoulder Elbow Surg. 2001;10:23-7.

Asheesh Bedi, Alice JS. Fox, Paul E. Harris, Xiang-Hua Deng, Liang Ying, Russell F. Warren, et al. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg. 2010;19(7):978-88.

Robert Z. Tashjian, Ralph F. Henn, Lana Kang, Andrew Green. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear. J Bone Joint Surg Am. 2004 Feb;86(2):355-62.