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Understanding Rotator Cuff Tears: Prevalence, Risk Factors, and Treatment Strategies for Optimal Outcomes: By Dr. Mike Wall

Rotator cuff tears are quite common, especially among older adults. In the U.S., it is estimated that around 2 million people are affected by rotator cuff injuries or tears each year. This includes both full-thickness tears (where the tendon is completely torn) and partial-thickness tears (where the tendon is partially torn). It is possible to have a torn rotator cuff tendon without having a specific injury. However, falls on an outstretched arm are notorious for causing rotator cuff tears.

The incidence increases with age, with tears becoming more common after the age of 40. Studies suggest that by the time people reach 60, nearly 30-50% of individuals may have some form of rotator cuff tear.  Shoulder pain that is persistent and lasts for more than a few weeks despite relative rest should be evaluated.  Partial thickness tears (less than 50%) can often be managed conservatively but do need monitoring to make sure they are not progressing. In our experience, PRP injection directly into the tear can be very helpful in patients with partial tears, especially when coupled with a very specific rehabilitation program.  

For symptomatic tears that are not successfully treated non-surgically, arthroscopic surgery to repair the torn/damaged tendon has proven to be very reliable in our hands. The surgical results are primarily related to three factors:  

• the size of the tear

• the degree of tendon tear retraction/tissue loss

• the quality of the tendon tissue (ie, degree of degeneration)

These three factors tend to become less favorable with passage of time. When treatment decisions are delayed, many untreated tears will expand in size and will be associated with tendon retraction. This will additionally lead to degradation in the quality of the tissue, thereby making repair probability less likely, leading to poor outcomes and dissatisfaction with care. Therefore, timely evaluation and proper treatment decision making on the proper treatment pathway is critical to achieve the best outcome.

Can degenerative disc be treated with PRP to help heal or toward stop further degeneration? Will SOAR be offering a discount package for more than 1 injection?

Degenerative discs in the spine that cause pain remain a treatment challenge. On occasion the disc itself is the pain source a phenomenon called discogenic pain. When other sources of pain such as facet joint pain, segmental pain from instability with axial or shear stress, can be eliminated as causes, direct treatment of the disc with PRP (platelet rich plasma) is an option. In our experience it tends to work best when the segment is no more that 30% collapsed and their is no accompanying stenosis. Success rates range from 65-80% depending on the clinical circumstance.

Time frame to improvement is typically 3 months, but can take 6 months. Therefore patience is required. Multiple levels can be treated at the same time, if they are deemed to be symptomatic. 

It is our practice to charge a global fee for self pay procedures. Therefore the cost of treating one or two levels would be identical.