Rotator Cuff Surgery and Prolotherapy
Ross Hauser, M.D.

Did you ever wonder how a pitcher could throw a baseball over 100 miles per hour ? It is because of the tremendous flexibility these athletes have in their shoulders.

The shoulder joint is essentially a free-floating ball suspended in a ring of ligamentous tissue. The ball of the shoulder is not in a stable socket, like the hip joint. It is held into the joint by the glenoid labrum and glenohumeral ligaments. The structures that move the shoulders are the rotator cuff muscles. The rotator cuff muscles are required to stabilize the shoulder whenever the shoulder is injured. They get a double-whammy. Whenever the shoulder is injured you can bet the rotator cuff tendons are affected.
 

The most common cause of chronic shoulder complaints in the athlete is rotator cuff tendonitis, specifically weakness of the supraspinatous tendon. In pitching, the arm is repeatedly abducted and externally rotated and this puts a strain on the rotator cuff, resulting in frequent tears or injuries. Poor circulation in the rotator cuff tendon increases the likelihood that degeneration of the tendon will occur with repeated injury. Knowing whether the rotator cuff tendon is completely torn is a key thing to know in order for the athlete to determine the best course of action. A complete rotator cuff tear needs immediate surgical repair. This is usually manifested by the athlete's inability to lift the arm overhead and is almost always the result of severe trauma. The athlete will have good range of motion away from the body, if someone else moves the arm. The athletes with complete tears will only be able to move their shoulders about 30 degrees on their own.
 

MRIs of the Shoulder Are Often Misleading

Unfortunately for the athlete, MRIs are frequently used as the basis for determining the need for surgery; however, as with other areas of the body, a shoulder MRI can be very misleading. MRIs done on completely asymptomatic individuals show a high prevalence of tears of the rotator cuff. In one study by Dr. C. Neumann 89 percent of the MRIs on totally asymptomatic shoulders showed abnormalities in the rotator cuff. In another study by Jerry Sher, M.D. and associates, 34 percent of the individuals showed a partial tear of the rotator cuff and 15 percent showed complete full-thickness tears. These again were in people with full range of motion of their shoulders with absolutely no symptoms. His conclusion was that surgical intervention based on MRI findings alone is not warranted. Another study showed that physical examination was actually better for diagnosing shoulder injuries than MRI. This study even included the diagnosis of glenoid labrum tears. MRI scanning in this study only picked up 59 percent of the tears. Athletes, use caution if a surgeon wants to scope or scalpel you because of MRI findings.
 

Flaws with Rotator Cuff Surgery

Rotator cuff surgery is not a complication-free surgery. A study done at the Mayo Clinic in 1997 by Dr. Mansat and colleagues reported a complication rate of 38 percent in shoulders undergoing rotator cuff repair. In order of frequency, the complications of the surgery were Frozen Shoulder, deep infection, and dislocation. Many of these patients who developed frozen shoulder had undergone a second surgical procedure to remove the adhesions. Another study, also done at the Mayo Clinic, looked at the surgical repair of partial thickness rotator cuff tears. Fifteen percent of their patients had an unsatisfactory result, and two-thirds of the patients in that group were patients who had already had an unsuccessful previous surgery.
 

Not all of the complications of surgery are physical. Some are financial. A study done in 1995 analyzed the cost of "successful" rotator cuff repair surgery. The costs ranged from $25,870 to $100,280, and the average time to return to full duty at work was from seven to 18 months depending on the health care system. These statistics are not very appealing to the athlete. Can an athlete be out of their sport for a year and then do rehabilitation for another year and expect to perform at the same level? Compare these statistics to Prolotherapy of the shoulder. The cost is often less than $1,000 for the complete series and the athlete takes essentially no time off from their athletic training.
 

It is for these reasons that many athletes are curing their athletic shoulder injuries and enhancing their athletic performance with Prolotherapy.

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