Dr. Keith Roach: Surgery is the answer for major tears of rotator cuff
Dear Dr. Roach: Several months ago, I noticed a slight pain in my right shoulder, and a month later, pain in my left shoulder. The pain got steadily worse in both shoulders. My doctor took X-rays, gave me cortisone injections and prescribed exercises. However, the pain worsened, requiring a visit to the ER, with pain pills and a sling. My doctor then ordered MRI scans of both shoulders.
I have a torn rotator cuff in both shoulders, and the doctor said I need surgery on both. From what I understand, that kind of surgery is done only as a last resort, due to the long and hard recovery period. I can use my right arm with some pain, but my left arm is almost useless. The pain starts in the shoulder and ends in my wrist. It is awful. I cannot lie down at night, drive, dress myself or lift anything.
Is surgery the only answer for this kind of injury? What will happen if I do not get the surgery?
Dear B.G.: I looked at the MRI reports you sent me and found that, unfortunately, in both shoulders, you have a full thickness, acute tear of the supraspinatus tendon (one of the four rotator cuff muscles). On the left, you have a 75 percent tear of the infraspinatus tendon (another one of the rotator cuff muscles). A full thickness tear is considered by most orthopedic surgeons to be a clear indication for surgery, since without surgery, the muscle can atrophy, making surgery at a later time more difficult, with poorer results.
Without surgery at all, it is very likely that you will not recover use of the shoulder and may develop severe arthritis in the joint as well.
Most rotator cuff tears I see as an internist are partial thickness tears. The majority of these can be successfully treated with physical therapy. However, given the degree of disability you have in your left shoulder, your doctor was absolutely right to obtain the MRI scan and to give you a clear recommendation for urgent surgical referral.
Dr. Roach writes: A recent column on home treatment for eczema generated many reader comments. These included one reader who noted that her symptoms went away entirely with institution of a gluten-free diet. Although dermatitis herpetiformis is the classic skin condition associated with celiac disease, eczema can be as well.
However, I don’t recommend starting a gluten-free diet without a diagnosis of celiac disease. The blood tests are unreliable shortly after a gluten-free diet is instituted, and it is important to be sure of the diagnosis before committing to a lifelong restrictive diet.
Other recommendations I received from readers included the use of ultraviolet light. When given medicinally (usually in a dermatologist’s office), this is considered a valid treatment for eczema. I am concerned about readers using the sun, given the risk of melanoma and other skin cancers.
One reader found that eczema on the feet was related to contact from a carpet. Another reader noted that using a thick cream and then wrapping the affected area in plastic wrap overnight improved its effectiveness, which is something that has been proven and that I am glad to pass on.
Email questions to ToYourGoodHealth@med.cornell.edu.