Cutting-edge Treatment for Rotator Cuff Tears

Each year, Washington Health Orthopedics sees thousands of cases, from the seemingly simple to the complex. More than half of all shoulder complaints come from rotator cuff tears.

The rotator cuff is a group of four muscles and their tendons that surround and stabilize the shoulder joint. It provides stability to the shoulder joint, helps lift and rotate the arm and allows for a wide range of motion. Rotator cuff injuries are the most common cause of shoulder pain and account for up to 70% of all shoulder injury cases. They are the leading cause of shoulder pain and dysfunction, and are linked to a wide range of injuries, from acute tears caused by trauma, to chronic tears from wear and tear. As the population ages, rotator cuff tears are increasing.

To provide information on these injuries and how to treat them, Washington Health will host a Health & Wellness presentation on rotator cuff repair on Wednesday, Dec. 17, at 5 p.m. The seminar will be presented by John Costouros, MD, FACS, FAAOS, orthopedic surgeon and globally recognized expert specializing in the comprehensive treatment of shoulder disorders using both arthroscopic and open surgical techniques. Dr. Costouros has developed innovative techniques and devices to treat rotator cuff tears; the session will focus on these new treatments and techniques that offer better outcomes to relieve pain and restore strength and mobility.

“The shoulder is the most mobile and complex joint in the human body, with an intricate arrangement of structures working together to provide the movement necessary for daily life,” Dr. Costouros explained. “That mobility can be reduced if the tendons are over-used through repetitive motions or high stress athletics, or degeneration over time as people age. This can lead to deterioration and tearing of the rotator cuff, which can also lead to significant pain with daily activities and even during sleep.”

Dr. Costouros noted shoulder injuries in younger people tend to occur as the result of a high-energy injury to the rotator cuff associated with throwing or overhead sporting activities. In older people, rotator cuff tears tend to be the result of wear and tear over time, but a specific injury or trauma may accelerate tearing and lead to severe pain and loss of function.

Symptoms of a rotator cuff tear include shoulder pain, which can be debilitating; weakness in the arm; a clicking or popping sound in the shoulder; and difficulty sleeping on the affected side. In some cases, patients have no symptoms or mild symptoms and continue to use the arm and shoulder causing further damage. Rotator cuff tears are diagnosed through a physical exam and imaging tests, such as X-ray or MRI that can help determine the extent of the tear and the best course of treatment. When a rotator cuff tendon is fully torn, the muscle and tendon degenerates over time and this process is not reversible unless repaired surgically. For Dr. Costouros, relieving pain goes hand in hand with restoring function.

“In many cases of rotator cuff tears, we initially begin with conservative treatment, including physical therapy, anti-inflammatories and injections,” Dr. Costouros said. “But ultimately, if there’s a structural problem like a full-thickness tear, most patients benefit more predictably with surgical treatment.

“I pinpoint the patient’s specific problem and if surgery is indicated, I recommend the ideal operation to address the problem based on every patient’s unique situation,” he continued. “It’s our job to find the best match to both relieve pain and restore mobility and function, then make sure they have adequate physical therapy after surgery to maximize the results of surgery and maintain that function.”

New Treatment Modalities

Dr. Costouros said surgical treatment for rotator cuff tears can range from arthroscopic repair, to revision repair, to new treatments using patches and other ways to augment tissue. Whenever possible, he opts for minimally invasive arthroscopic surgery. For the past four years, he has been treating some large irreparable rotator cuff tears with an innovative minimally invasive arthroscopic procedure using a biodegradable balloon implant placed above the rotator cuff. This arthroscopic procedure has led to very promising results in select patients so far.

As in all arthroscopic procedures, the surgeon makes a few small, dime-sized incisions in the shoulder for the arthroscope (a small tube with a high-definition camera and monitor). The arthroscope and surgical tools are inserted into the shoulder joint to measure the space and position the balloon implant. Once in place, the balloon is inflated with saline to create a cushion. This cushioning helps intact shoulder muscles function more effectively, offers greater pain relief and enables patients to start physical therapy sooner. After about a year, the balloon is absorbed by the body. “Technique and experience are critical -- I have very detailed protocols,” Dr. Costouros said. “There are better ways today to modulate some of the side effects of anesthesia and the pain of shoulder surgery, which historically was very, very painful. We use multimodal anesthesia to enhance both outcomes and the patient experience.”

“It’s an art and a science when it comes to rotator cuff treatment, because all tears are different, and there are several ways to anchor them down, to use sutures, to use anchors of various designs, and to augment tissue as needed,” he continued. “My approach is identifying the problem, selecting patients that would benefit from surgery, and then doing the ideal surgery for the best outcome. We work to improve pain control, improve the patient experience, and improve the quality of life for our patients.”

For more information about rotator cuff repair, plan to view Dr. Costouros’ seminar on Wednesday, Dec. 17, at Facebook.com/WashingtonHealth1 or on YouTube.com/@WashingtonHealth. Following the presentation, the seminar will be added to WH’s video library on its YouTube page. Additional information and educational material is also available at californiashoulder.com.