Shoulder injury? Surgery is not the only option

Fern Kornelson was walking with a friend to dinner when she fell and ended up on a snow pile, on her back, with her arm pinned behind her body. The pain was excruciating, she felt nausea and on the verge of fainting. After the physician put her shoulder in place, he gave her a choice — rotator cuff surgery or treatment.

“I chose treatment. I thought that surgery would tie me up for a long time,” says Kornelson, who was 65 at the time. Ten years later she is still leading an active life and has started barrel racing.

Many people believe if their rotator cuff is torn, they need to have surgery. New research shows that is not the case and treatment of tears can be managed successfully without an operation.

Managing without surgery

“If you have a rotator cuff tear, you don’t necessarily need an MRI or a referral to a surgeon,” says orthopedic surgeon Dr. Richard Boorman, MD, University of Calgary Sport Medicine Centre, Faculty of Kinesiology and Cumming School of Medicine.

“A sport medicine physician or a physiotherapist can help manage your rotator cuff tear, often with just one or two visits, and by teaching you exercises that you can do at home to help your shoulder,” adds Boorman from the University of Calgary Sport Medicine Centre, Faculty of Kinesiology and Cumming School of Medicine.

A published study by Boorman’s team found that 75 per cent of patients were successfully treated without surgery and this was maintained up to five years later. Boorman anticipates that surgery still won’t be needed for most patients even 10 years after the injury.

Patient and surgeon collaboration

The study included 100 patients, including Kornelson, who had a full-thickness tear — torn right through from top to bottom — of their rotator cuff shown on ultrasound or MRI, and who had been referred to one of the shoulder surgeons at the University of Calgary Sport Medicine Centre, part of the Faculty of Kinesiology.  

All patients were assessed by a sport medicine physician who determined if they met the criteria to participate in the study, and if they did, then the physician assessed their shoulder. The patients worked with a physiotherapist to learn a specialized set of exercises they were to perform at home and for followup at regular intervals. After the three months, patients met the surgeon to whom they had originally been referred. 

“Together — the patient and surgeon — decided if the treatment program was ‘successful’ and that surgery was not an appropriate intervention, or if it ‘failed,’ meaning surgery was the best option because significant symptoms still persisted,” says Boorman. 

Unique tool helps avoid surgery

Some people are debilitated by a rotator cuff tear while others may not even know they have one. A questionnaire known as the RC-QOL (rotator cuff quality of life index) was used as a tool in the current study to help clinicians understand how much a rotator cuff injury impacts a patient’s life. It was created by Drs. Nick Mohtadi, MD, Bob Hollinshead, MD, and their research team at the Sport Medicine Centre in 2000.

“The RC-QOL also allows us as clinicians and researchers to track a patient’s progress (or lack of) over time to evaluate if a course of treatment is actually working for that patient,” says Boorman.

Authors

The paper entitled: “What Happens to Patients When We Do Not Repair Their Cuff Tears? Five-Year Rotator Cuff Quality-of-Life Index Outcomes Following Nonoperative Treatment of Patients with Full-Thickness Rotator Cuff Tears,” in the Journal of Shoulder and Elbow Surgery, is by Dr. Richard S. Boorman, MD, FRCSC, Sport Medicine Centre, Faculty of Kinesiology, and the Department of Surgery, Cumming School of Medicine; Kristie D. More, MSc, Sport Medicine Centre, Faculty of Kinesiology; Dr. Robert M. Hollinshead, MD, FRCSC, Sport Medicine Centre, Faculty of Kinesiology, and the Department of Surgery, Cumming School of Medicine; Dr. James P. Wiley, MD, Sport Medicine Centre, Faculty of Kinesiology; Dr. Nicholas G. Mohtadi, MD, FRCSCa, Sport Medicine Centre, Faculty of Kinesiology, and the Department of Surgery, Cumming School of Medicine; Dr. Ian K.Y. Lo, MD, FRCSC, Cumming School of Medicine; and Dr. Kelly R. Brett, MD, Sport Medicine Centre, Faculty of Kinesiology.

About the Sport Medicine Centre

The Sport Medicine Centre in the Faculty of Kinesiology provides quality care in physiotherapy, massage therapy, athletic therapy, performance nutrition and X-ray services alongside a team of sport medicine physicians and orthopaedic surgeons. It is the hub of sport medicine research since being established at the University of Calgary during the 1988 Winter Olympic Games. It delivers integrated care to elite and recreational athletes on campus and in the community. Find out more.