Elderly Can Benefit From Rotator Cuff Surgery, Too
May 29, 2001 -- Shoulder surgery to repair rotator cuff tears in people over 65 can provide long-term pain relief and a higher level of function, and help patients maintain an independent lifestyle, according to a new study.
Conventional wisdom holds that older patients should be treated conservatively -- with medications like anti-inflammatory drugs and corticosteroid injections, and physical therapy -- partially because tears are thought to be a natural, inevitable phenomenon as a person ages, partially due to concerns over poor results after surgery, and partially due to safety concerns during surgery in this older population.
But not everybody responds to conservative treatment; even among those who do, there is the possibility of reinjury. In those cases, surgery is the only alternative to ease the near-constant pain.
"In rotator cuff pathology, there are two different subgroups -- and this applies generally but especially to this age group," explains Gary McGillivary, MD, assistant professor of orthopaedics at Emory University Medical School, in Atlanta. "One would be a traumatic rotator cuff tear -- someone slips and falls, causing sudden onset of injury; this is unusual in this age group. The second group is patients with a degenerative rotator cuff tear. Those are very, very common. It's due to chronic impingement of the rotator cuff tendons on the undersurface of a piece bone [called the] acromion: They jam, they thin, they fray, and eventually they tear. If you look at certain studies, the problem affects 40% of the population over the age of 70."
McGillivary, who was not part of the study but reviewed it for WebMD, says a large majority of patients with degenerative problems respond well to simple, nonsurgical therapies (corticosteroids and physical therapy to strengthen their rotator cuff muscles and other muscles around the shoulder). But for patients in the first group, and those who don't respond well to conservative treatment in the second group, McGillivary says surgery should be considered.
But the question remains: How well do these patients do in the long run?
Orthopaedists led by Mustafa Yel, MD, from the Selcuk University Medical Faculty (Turkey), studied the long-term results of surgical rotator cuff repairs in 47 patients who were 65 years old or older at the time of their procedure. None of them had responded satisfactorily to earlier conservative treatment for their condition.
The patients were brought back an average of nine years after the initial procedure and rechecked. They were tested for range of motion and strength, put through two standard evaluations, and asked about patient satisfaction and pain.
The researchers report that subjectively the patients were highly satisfied and all but three of the 47 continued to report subjective improvements. Objectively, only 10% of the procedures were classified as unsatisfactory, while 51% were satisfactory and 39% were excellent. No patient who was rated satisfactory or better developed an unsatisfactory result with the passage of time. Only two patients saw their condition deteriorate, each due to a golf injury.