Which surgery is better for supraspinatus tendon tear?

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Thank you for sharing all the documents. I have reviewed them in detail (attachments removed to protect the patient's identity), and my assessment is as follows:

Although I have the images available, I lack details about the clinical examination. The physician's notes you shared mentioned only the surgery without addressing the clinical examination.

I assume that if surgery were recommended, there would be significant weakness in shoulder abduction and no relief from conservative management.

The supraspinatus is the primary muscle of the rotator cuff and is the most commonly injured. A complete tear indicates that there is no continuity, resulting in a total loss of function. Surgical repair is necessary to restore this continuity; if not performed, it may lead to early shoulder arthritis.

Once shoulder arthritis develops, the only treatment option is shoulder replacement, a more complicated procedure than rotator cuff repair. Therefore, it is advisable to proceed with the surgery.

Now, regarding the best type of surgery for you:

A three cm gap should be augmented. First, let us clarify what augmentation means and why it is done. The failure rate of rotator cuff surgery can be very high, ranging from 20 % to 80 %. Augmentation helps to reduce this failure rate.

The indications for augmentation depend on the surgeon's experience and may include factors such as the muscle condition on MRI (magnetic resonance imaging), the gap between the two ends, and any comorbidities. In my practice, I augment all patients if the gap is greater than 2.5 cm.

In your case, the gap is borderline, but the absence of muscle atrophy is a positive sign that should help secure the sutures effectively. That said, your surgeon may have different principles and should proceed with what he is most comfortable with.

There are various augmentation methods, such as growth factors and allografts, and the choice will depend on the surgeon's preference and experience. In summary, you definitely require surgery, and your surgeon will determine the specific type. Predicting the best approach based solely on the MRI is challenging. I have provided my recommendation regarding augmentation.

I hope this answers your query. Feel free to reach out anytime.

Thank you.

Hi,

Welcome back to icliniq.com.

As I mentioned earlier, I go for augmentation if the gap is more than 2.5 cms. Therefore, in my opinion, your surgical plan should be option 2.

Having said that, this again depends on surgeon to surgeon. This is not a black and white case. Every surgeon can have different plans and different ways to do it. So you need to discuss that with your surgeon.

There are no serious complications with this procedure. The most common is failure of repair. The incidence is 20 to 80 %.

Other complications could include wound complications, infection, and, in a very rare case, neurovascular injury. The chances of wound complications for a hybrid are higher than for an arthroscopic procedure, but still, it is not very common.

I hope this answers your query. Feel free to reach out anytime.

Thank you.