multiple rotator cuff tears

I am a 45 year old woman who now has her 4th rotator cuff tear in addition to arthritis and bone spurs.  I have been told there is nothing anyone can do for me including the bone spurs.  This is my right arm and I am right handed.  I can not lift my arm and I am in constant pain.  I was told that I am "Too young" for a replacement.  Two doctors in the same practice have seen me.  Is this accurate or should I look for another doctor in another practice?

[JainMD]

Hi Robin,
I feel if there is multiple rotator cuff injuries with shoulder joint arthritis and bone spurs, which is not getting healed with initial management should go for definitive surgery.
Is arthroscopy been done? If yes, then how many times it is been performed? Do you feel that has helped you?
Arthroscopy with associated debridement and synovectomy can relieve pain, improve function, and delay progression of the disease for inflammatory arthropathies.
Arthroscopic procedures addressing osteoarthritis consist of debridement, loose body removal, chondroplasty or abrasion of the glenoid and humeral head, and capsular release.
An inferior humeral osteophytes or bony spur that blocks motion in athletes may be removed arthroscopically.
Do you have subluxation of femoral head by any chance?
Prosthetic shoulder replacement is a highly reliable surgery for pain relief (*).
A hemi-arthroplasty replaces the humeral head; a total shoulder arthroplasty also replaces the glenoid.
Shoulder replacement should not be expected to restore normal shoulder motion (2).
For patients with primary osteoarthritis, total shoulder arthroplasty provides better results than hemi-arthroplasty for pain, mobility, and activity.
It is an easy, economical, and dependable method of treating shoulders severely affected by rheumatoid arthritis.
I think you should discuss this with your orthopaedician and stress on going in for shoulder replacement.
Younger the patient better is the healing.
Keep me informed regarding your decision and about your discussion with orthopaedician.
Bye.




*Edwards TB, Kadakia NR, Boulahia A, et al. A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: Results of a multicenter study. J Shoulder Elbow Surg 2003;12: 207 to213.

[robin1000]

Thanks for your reply.  Yes I have had 3 arthroscopy procedures, and the end result is that the rotator cuff tears - again.  I do believe that subluxation of femoral head was diagnosed at the last surgery.  I was told that the bone is completely exposed.  My problem is not that I do not want to go forward with surgery, I am told by two surgeons that no one can help my problem and I have been told to get used to it.  I feel hopeless because I do not know who to see at this point as there are only two surgeons in my plan.  I am in the San Diego area and I do not know where to turn.  I do not expect to ever regain 100% in my arm, right now I can't even eat with the arm.  

Thanks a million

[JainMD]

Hi Robin,
I believe you spoke about your upper arm in first post as "This is my right arm and I am right handed.  I can not lift my arm and I am in constant pain" and now in your second post you are mentioning about femoral head as " I do believe that subluxation of femoral head was diagnosed at the last surgery" .

[robin1000]

I guess I am confused by your question.  I seem to remember some mention of the femoral head but I could be wrong.  

[JainMD]

Hi Robin,
Is that your name? It's a nice name.
I am sorry I can see that I had asked you regarding subluxation of femoral head. I am not sure in what context have I asked about femoral head.
Nevertheless, is it that you had subluxation of femoral head or humeral head?
What are the doctors planning for your shoulder? What definitive surgery are they thinking about?
I think healing would be faster post-operatively.
When is your next visit to orthopaedician?
I would be interested to know the progress.
Keep me informed.
Bye.

[robin1000]

I am not sure about the subluxation at all, it is just one of the words being thrown at me.  I know for sure that I have a rotator cuff tear, arthritis and bone spurs.  The problem I am having is that I do not have an appointment to anyone.  There does not seem to be a doctor in my area willing to deal with this at all.  They say there is no surgery to help me and I am suppose to just deal with this.  That was the end no other appointments.

Thanks!

[JainMD]

Hi,
Which country do you belong to? Which city do you belong to?
What are the other options you have for you?
If you don’t have any body to operate right now, whom are you going to see?

[robin1000]

I am in California.  I don't know what I am going to do.  I can't get any doctors to even return phone calls.  It is very aggrivating.  I need a doctor that looks at this situation as a challenge and not a burden.  My arm is so bad that doctors don't want to deal with it.

[robin1000]

I have had 2 doctors tell me that they hold very little hope for me and do not think a replacement is a good move for me.  I was told the surgery is only a 50% chance of helping the pain or the movement.  I have an appointment with a Dr esch I heard he is good, I have not seen him yet.

[JainMD]

Hi,
What kind of surgeon is Dr. Esch? What does he specialize in?
I think you should be taking as much opinion as possible as this would make sure of what treatment approach to follow.
You have posted after quite a long time, how is your health otherwise?
Keep me posted.
Bye.

[robin1000]

Hi,

He is an orthopedic surgeon specializing in shoulder arthroscopy.  One doctor has told me there is nothing that can be done.  One doctor told me I could have a shoulder replacement but the success rate is 50 percent and told me to think long and hard before going in for surgery.  This will be my third and last opinion.  I hope I get better odds from this doctor.  My health could be a lot better.

Thanks,

Robin

[JainMD]

Hi,
Open, mini-open, arthroscopic repair can be attempted. Arthroscopic repair allows for complete evaluation of the shoulder but is technically challenging. Type of rotator cuff tear and pattern may dictate procedure.
Chronic rotator cuff tears with rotator cuff arthropathy have a poor prognosis.
Repair failure is higher in those who smoke, have diabetes, or undergo too-aggressive rehabilitation.
All the best and do keep me posted.
Bye.