Rotator Cuff Tendinosis: Is a Cure Possible [Updated]

Rotator cuff tendinosis is a very common cause of shoulder pain in the adult population.  By definition, rotator cuff tendinosis means that your rotator cuff tendons are starting to show their age.  In other words, the rotator cuff is starting to degenerate or wear out.  Most rotator cuff tears are due to this degeneration or wearing out of your rotator cuff tissue. Many people with rotator cuff tendinosis have severe pain at night.   Until recently there were very few good surgical options for people with rotator cuff tendinosis.  With a recent invention, surgery might be able to cure rotator cuff tendinosis.  Before we review a promising new procedure to treat tendinosis,  let’s consider the following.

There are many potential causes of your rotator cuff tendinosis:

• Age
• Genetics
• Overuse
• Various overhead activities

Most of you with rotator cuff tendinosis have severe pain on the side of your arm.  Reaching into the back seat of your car is brutal.  Rotator cuff tendinosis also causes severe night pain in the shoulder and can lead to many sleepless nights.

Once rotator cuff tendinosis is present and your rotator cuff begins to degenerate, the rotator cuff can go on to tear more easily. Initially, only a small portion of rotator cuff may separate from the bone.  We will call that a partial thickness rotator cuff tear.  As rotator cuff tendinosis progresses further, the rotator cuff tendon may continue to tear, thus leaving you with a full thickness rotator cuff tear. The graphic below shows the progression of rotator cuff tendinosis to a full rotator cuff tear.

What Is The Treatment For Rotator Cuff Tendinosis?

Initially, non-surgical management is started to address your pain and improve your quality of life.  Many people with rotator cuff tendinosis can be successfully treated with:

• Physical Therapy
• Anti-inflammatory medications
• Activity modification and rest
• A cortisone or steroid injection

A small percentage of you will not improve with the these treatments.  Your shoulder continues to hurt and your quality of life is poor.  What other treatments can we offer you?

Can Surgery Cure Rotator Cuff Tendinosis?

Millions of patients suffer from rotator cuff tendinosis and a significantly affected quality of life.  You’re not sleeping well, you have a hard time working and you can no longer play ball with your children.

Before the development of a recent patch to try and regenerate a degenerative rotator cuff  our approach to the surgical management of rotator cuff disease was “mechanical”.  That means that we put a camera into your shoulder and were able to remove the inflamed tissue or bursitis, and possibly any bone spurs that were present. The problem used to be that we couldn’t do anything to try and reverse or repair the tendinosis.

Rotator cuff tendinosis is truly a disease, it is a BIOLOGICAL problem. Our rotator cuff tissue is degenerating; and nothing we did previously addressed the underlying change in the biology of the tendon.  By removing the inflamed tissue, we simply dealt with the effects of the tendinosis, and not the tendinosis itself.  That is why surgery to remove bone spurs and inflammatory tissue alone had mixed results.

This new procedure enables us to arthroscopically (minimally invasive) place a “bioinductive” patch over the area of rotator cuff tendinosis or even a partial rotator cuff tear. The research shows that over time the patch can regenerate the rotator cuff tendon.  We finally have a BIOLOGICAL means of treating your shoulder pain. Some early research shows the patch is healing degenerative rotator cuff partial tears and tendinosis.

How Does The Rotator Cuff Patch Work?

Once that patch is in position on the rotator cuff it begins to “induce” the rotator cuff to repair or regenerate itself.  This has been shown to lead to healing of partial thickness rotator cuff tears, and potentially reverse the degenerative changes.  For those of you with rotator cuff tendinosis, but no tear — it is possible that this bioinductive patch could prevent your rotator cuff from degenerating further into a situation where you now have a partial rotator cuff tear.

The graphic below shows that patch in place and the healing of the tendinosis and a partial rotator cuff tear.

For too many years the orthopedic community has addressed rotator cuff tendinosis and partial tears from a purely mechanical perspective.  Short term relief of pain was possible … but many of you noticed that your pain returned months or years later.  As research begins to reveal the underlying biological issues that are present, it is incumbent upon the agile companies in the sports medicine space to bring new technologies to address the biological cause of your pain.  By addressing the biology and attempting to reverse those changes we have a chance of not only significantly improving your quality of life in the short term, but for many decades to come.