Question:
I have had two surgeries for the same shoulder cuff repair. The last one was in August 2013. I am still in so much pain. I really do not know what to do now. I had to take 8 months off work during 2013. I can’t do that again.
Answer: I can only imagine the despair you must be feeling. Going through two operations is a very big deal. But if it’s any consolation, you are not alone when it comes to failed shoulder surgeries.
Problems with this part of the shoulder are fairly common, especially among older individuals. And, unfortunately, surgery doesn’t get rid of the pain in all cases, says Dr. Robin Richards, an orthopaedic surgeon at Sunnybrook Health Sciences Centre.
The rotator cuff is a thick tendon that surrounds the upper end of your arm bone, or humerus. A total of four muscles are connected to the tendon.
“The muscles that attach to the rotator cuff tendon centre the humeral head in the joint, give the arm strength and allow the shoulder to move in almost any direction,” explains Dr. Richards.
With increasing age, however, the tendon becomes worn, thinner and weaker. It can also be damaged, or torn, through falls, accidents, sports injuries and repetitive use. And, as you have obviously experienced, the area can become inflamed and very painful.
Dr. Richards compares the tendon to the heel of a sock that gradually wears out. Ideally, you would like to buy a new sock once there’s a hole in the heel. Unfortunately, the tendon can’t be replaced and must be stitched back together – much like darning a patch for a hole in an old sock.
Even with surgery, patients may not fully regain their previous range of motion and strength.
“You can make people better but you can’t make them completely normal,” says Dr. Richards.
The main goal of surgery is usually to permit the regular use of the shoulder without pain – or, at least, with reduced pain.
During the operation, inflamed tissue surrounding the tendon may be removed and heavy polyester sutures are used to repair the tear and re-attach the tendon to the bone. Recovery after surgery takes 3 to 4 months, and involves physiotherapy.
The success rate for rotator cuff surgery is between 80 and 85 per cent, says Dr. Richards. The chance of the surgery making you worse is about 2 to 4 per cent. Possible complications from surgery include infection, bleeding, nerve damage and residual stiffness.
Your chance of successful treatment declines with each additional surgery.
So what do you do now after two surgeries have essentially failed?
Before you can treat your continuing pain, you need to know what’s causing it.
Dr. Richards points out that many things can go awry with the operation and that’s partly because the surgeon is attempting to repair what amounts to worn-out tissues. “Sometimes the tendon doesn’t heal or the sutures pull through the tendon,” he says.
You will need to be re-examined and the doctor will likely send you for more ultrasound images – and possibly a MRI – of your shoulder.
Some thought should also be given to the question of whether the original diagnosis was correct and if the previous surgeries were appropriate.
Your doctor “has to figure out what the diagnosis is; was the surgery indicated. If so, was the correct operation performed, and was there a problem with the way the surgery was performed. Or, has something happened since then, ” explains Dr. Richards.
It’s certainly worthwhile getting another doctor’s point of view on these questions.
You can ask your surgeon to refer you to a physician who specializes in shoulders.
“I don’t think many doctors would be offended or upset if someone wanted a second opinion,” he adds. Be sure to take a copy of your medical records, and any diagnostic images of your shoulder, with you to the appointment with the other specialist. It may help speed up the assessment process.
Dr. Richards also recommends writing down your questions in advance. It takes time to arrange a second opinion, so you will want to make the most of the appointment.
If another surgery is recommended, ask about the chances of a positive outcome. “There is a general rule that the success rate deceases – and the complication rate increases – with each operation.” He says the success rate for a second operation is about 70 per cent and a third operation will only be less than that figure.
He says the most common reason people choose shoulder surgery is that the pain is interfering with their ability to sleep at night. Or, they experience pain while performing daily activities such as cooking, cleaning, grocery shopping or driving.
Of course, you could be fed up with surgery – and justifiably so. You may need a team approach involving several health-care providers such as a pain specialist, as well as hands-on practitioners like physiotherapists and massage therapists.
Talk to your family doctor about these other options. But, first, it would be extremely helpful to know why the previous surgeries failed. As Dr. Richards puts it: “You need to look at the specific aspects of this case.”
