Shoulder Replacement Recovery: Rotator Cuff Damage the Unwelcome Surprise…

by Chris Centeno, MD /

shoulder replacement recovery

Way back when, at the turn of the century, the concept of the free lunch was introduced. It was offered by pubs owned by beer companies as a way to entice workers to buy more beer over their lunch hour. It included lots of salty items that went well with beer, prompting the proverbial retort that “there is no such thing as a free lunch.” The concept can also be applied to shoulder replacement surgery. The idea appears appealing—your shoulder joint is worn out, so you go in and get a new part.

Not so fast says a new study, as its findings demonstrate that shoulder replacement recovery generally includes damage to the rotator cuff! This new research found that no matter how the new shoulder prosthesis was arranged and how the rotator cuff muscles were repaired, the muscles never functioned normally. This led the authors to conclude that abnormal forces on the new shoulder could well have a devastating long-term impact on the new joint, which may explain why patients often tell us that their new shoulder isn’t all it was cracked up to be.

Isn’t Shoulder Replacement Recovery a New Start? Why Would I Have Rotator Cuff Damage?

shoulder-anatomyTo answer that question, we first need to understand the shoulder joint. The shoulder is a very complex ball-and-socket joint that has the greatest range of motion of any joint in the body. To allow for that, its socket is particularly shallow, requiring a very elaborate system of tendons, called the rotator cuff, to keep it in its socket throughout its range of motion. This involves millisecond-timed and millimeter-oriented precision orchestrating the laxity of some ligaments and the tightness of other ligaments that allow the ball to stay in one small region in relation to the socket as you move. The rotator cuff is the most crucial part of this process as it is the greatest concentration of multiple tendons and attachment points. However, there are more instruments in this complex symphony as the strength of the ligaments insure that the humeral head stays in position as you move, and the labrum, which is a cartilage-like lip on the socket, increases the hold on the ball of the joint.

In addition to motion, these tendons, ligaments, muscles, and cartilage keep the bones that make up the shoulder together. The main bones making up your shoulder joint are the humerus, whose head forms the ball that fits into the socket of the scapula (shoulder blade); the acromion, which is a bony projection off the scapula; and the clavicle (collarbone), which meets the acromion and together they make up the acromioclavicular joint. Surgically removing the joint and then getting a metal prosthesis to successfully pair with the orchestration of this complex system without the biologic signals to control force and timing is incredibly difficult. Together with the damage done to the rotator cuff from the surgery itself, it’s easy to understand why these errors in messaging and force so often result in the rotator cuff damage so shockingly associated with shoulder replacement recovery.

What Causes Shoulders to Fail in the First Place? Shoulder Instability


Shoulder instability occurs when tendons and ligaments get stretched, torn due to trauma, or simply worn out due to age and cause too much motion in the joint. This additional motion leads to arthritis as sections of the joint are exposed to more wear and tear, bone spurs as your body’s solution to “shoring up” an unstable joint, and tears and stretching of the ligaments as they deal with forces they’re not designed to take. Rotator cuff tears are especially common as when the rotator cuff’s complicated multi tendon millisecond timing is off, damage occurs. So the trick is recognizing and treating instability when it occurs.

What Are My Treatment Options to Head Off Shoulder Replacement Recovery Altogether?

The best way to treat shoulder instability and the issues it causes is by using precise injections of your own platelets and stem cells. This will give your shoulder what it needs to heal without the additional burden of the healing required following the trauma from surgery.

We have many different treatment options available to us to treat shoulder issues. Our platelet procedures are often used, but when instability or arthritis is severe enough we take out the big guns and use our patented stem cell shoulder procedure Regenexx Rotator Cuff, which was specially formulated for the unique needs of the complex shoulder joint. When instability is the issue, using specially designed ultrasound, we can track progress over time and tweak if necessary.

The upshot? There is no free lunch here, as the biggest issue in shoulder replacement recovery is, amazingly enough, rotator cuff damage, so you’re going to pay for that new shoulder one way or another! Treat and keep your own shoulder as joints can be amputated and metal prostheses inserted, but they can never truly be replaced!

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8 thoughts on “Shoulder Replacement Recovery: Rotator Cuff Damage the Unwelcome Surprise…

  1. Lynn

    according to mri i have a large osteophyte on the inside of the joint where it cannot be scraped using arthroscopy. I may have a torn rotator cuff but do certainly have a torn bicep and tendonosis. I have also developed snapping scapula. Unfortunately, I have the cadillac of supplemental policies but cash poor. Is my only choice then, the arthroplasty? I am 68 but in good shape except for problems caused by an accident between an SUV and a bike-one of which is my shoulder because of the 10 out of 12 surgeries to follow, I lived upstairs and rather than go upstairs one at a time, I swung up on using my shoulders-wrong choice!

    1. Regenexx Team Post author

      Lynn,
      Osteophytes, (bone spurs) form as your body’s way of stabilizing an unstable joint and certainly a presumed rotator cuff tear, a torn bicep, tendinosis, and snapping scapula syndrome suggest major instability. Generally, when the instability is handled, the bone spur dissolves on its own over time, but if not it can be broken up by injection. Joint replacement should always be a last resort. Unfortunately, stem cell procedures aren’t covered by health insurance in the US, supplemental or otherwise, though 3 of our CA locations offer no interest financing for those who qualify. Please see: http://www.regenexx.com/find-a-physician/ and http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

  2. Kris Petersen-Gauthier

    My brother has a severed rotator cuff and has been told it’s inoperable and physical therapy is not recommended. Apparently he injured the same rotator cuff 7 years ago and it healed incorrectly. A similar recent injury brought this to light. Is his rotator cuff too far gone for regenexx? He is in his late 60’s.

    1. Regenexx Team Post author

      Kris,
      Rotator Cuff tears are things we treat regularly and your description does not appear problematic. http://www.regenexx.com/blog/dr-centeno-and-blecher-on-the-doctors-tv-show/ If you scoll down on this page you’ll find additional info on how we approach Rotator Cuff tears: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ http://www.regenexx.com/blog/shoulder-instability-recovery-time/ Obviously, something is causing the rotator cuff to tear repeatedly, which is were we would start. If your brother would like to be evaluated for Candidacy, please have him fill out the Candidate form.

  3. THOMAS WARWICK

    I was told by a my orthopedic physician after an MRI examination that I have a small tear of my left Rotorcuff, The Surgeon said surgery but I am not excited about the 3 month heal time frame. What time frame for regeneration will I be looking at for platelets and stem cell recovery?

    1. Regenexx Team Post author

      Thomas,
      Significantly reduced recovery, as there is no surgical trauma to recover from. Importantly, the rotator cuff tear needs to be established as the source of pain – it often isn’t. Please see: https://regenexx.com/blog/watch-advanced-image-guided-injection-shoulder-step-procedure-suite-dr-schultz/ and https://regenexx.com/blog/how-to-avoid-surgery-for-rotator-cuff/ and https://regenexx.com/blog/rotator-cuff-tear-causing-shoulder-pain/ and https://regenexx.com/blog/shoulder-surgery-side-effects/. If you’d like to see if you’d be a candidate, please submit the Am I a Candidate form.

  4. Esther kritharakis

    Hi, my name is Esther; however, this is not about me is about one of my family member diagnosed with severe rotator cuff damage. She is late 75 closed to 80 years old. Not going else where for a second opinion and under her physician’s nurse practitioners advised put her through some excruciating painful therapy without doing and MRI to see what the issue is. I pushed for the MRI until one was done only to find out that things are too far gone and the only things to do is to replace the shoulder. My concern is due to her age and recovery time. Over one or two visits the nurse practitioner convinced her that her route to go is to do replacement of the shoulder. I am a believer of steam cell replacement; however, my family member has not been explained the pros and cons about the entire replacement. What should I do.
    I am also an Occupational Therapist and a Lymphatic Therapist.

    1. Regenexx Team Post author

      Esther,
      In order to see if we can help, the first step would be to see if your sister is a Candidate. We will have someone contact you on Monday and assist you with that process. Here’s some information on why it’s best to avoid shoulder replacement: https://regenexx.com/blog/shoulder-replacement-recovery-rotator-cuff-damage/ and https://regenexx.com/blog/40-of-shoulder-replacements-in-patients-younger-than-55-fail-by-10-years/, especially in your sister’s age group. https://regenexx.com/blog/surgery-dementia-risk/ and https://regenexx.com/blog/general-anesthetics-and-dementia-new-research-raises-concerns/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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