Taking Vitamins for a Rotator Cuff Tear?

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Can taking vitamins or supplements help a rotator cuff tear? Can not taking them make things worse? A colleague sent me a paper on vitamin B12 and rotator cuff tears so I decided to take a deeper dive. Let’s dig in.

Rotator Cuff Tears

Your rotator cuff is the complex of muscles and tendons that help to move your shoulder joint. Tears are more common as we all age through both wear and tear as well as trauma. However, since rotator cuff tears are much less common in younger people, it’s clear that many have a degenerative component. Meaning the rotator cuff weakens as our native ability to repair it is unable to keep up with the demands we place on it. That can lead to a tear in one of the four tendons, most commonly the supraspinatus. While many tears are treated with eventual surgery, instead of surgery, we have pioneered using ultrasound-guided injections of bone marrow concentrate containing stem cells to help heal the problem (1).

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My Number One Consistent Question-What Can I Do?

In treating many rotator cuff patients every year without surgery, the number one question I get is what can I do to increase the chances of success for my procedure? That question invariably turns to supplements. So can various vitamins or supplements help your rotator cuff? Or can being deficient in various vitamins hurt the rotator cuff?

The B12 Study that Got this Topic Rolling

A colleague, Rob Kramberg, who often sends me research that ends up in the blog, sent me a recent study on vitamin B12 and degenerative rotator cuff tears (the type we aging athletes tend to get) (2). Basically, the study showed that people with lower vitamin B12 serum blood levels (by about 20%) were more likely to have a degenerative rotator cuff tear. Now that doesn’t mean that low B12 levels cause a rotator cuff tear, but since B vitamins are cheap and otherwise good for you, I’d put it in the category of “might as well take it” if you have a rotator cuff tear.

More Vitamins or Supplements?

So are more vitamins or supplements associated with rotator cuff tears or poor healing? This is what I found:

  • Low vitamin D levels are associated with poor healing and greater complications from rotator cuff surgery (3). There is also a reasonable amount of data on the idea that vitamin D is important for the type of tendon-bone healing needed in rotator cuff healing (8). Remember that this one is directly related to how much time you spend in the sun and outdoors and where you live. Meaning most northern parts of the world don’t produce enough sun in the winter to make your daily minimum vitamin D requirement, so winter-time supplementation is key.
  • Vitamin C supplementation in mice bred to have a deficiency in anti-oxidants helped rotator cuff tendons heal (4). Other animal models have shown the same thing (5).
  • Curcumin and Boswellia helped reduce post-op pain after rotator cuff surgery (7).
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A Word of Caution

While all of the above is encouraging, just realize that only a handful of this research is of the gold standard level where the researchers gave some people the supplement and others a placebo and then checked on rotator cuff tears or healing (6). So more work needs to be done. Having said that, I see no reason not to purchase some of these inexpensive supplements if you have a rotator cuff tear or are considering treatment, as they are in the “no harm no foul” category.

The upshot? There’s more on common vitamins and supplements and rotator cuff tears and healing than I would have thought. Given that these are all supplements that may have other positive effects and very few negative effects, I see no reason not to take them. Just respect the dosing parameters as some like Vitamin D can cause issues if taken in excessive doses.

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References:

(1) Centeno C, Fausel Z, Stemper I, Azuike U, Dodson E. A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis. Stem Cells Int. 2020 Jan 30;2020:5962354. doi: 10.1155/2020/5962354. PMID: 32399045; PMCID: PMC7204132.

(2) Kim JH, Kim GT, Yoon S, Lee HI, Ko KR, Lee SC, Kim DK, Shin J, Lee SY, Lee S. Low serum vitamin B12 levels are associated with degenerative rotator cuff tear. BMC Musculoskelet Disord. 2021 Apr 17;22(1):364. doi: 10.1186/s12891-021-04231-7. PMID: 33865356; PMCID: PMC8053277.

(3) Harada GK, Arshi A, Fretes N, Formanek B, Gamradt S, McAllister DR, Petrigliano FA. Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair. J Am Acad Orthop Surg Glob Res Rev. 2019 Jul 3;3(7):e075. doi: 10.5435/JAAOSGlobal-D-19-00075. PMID: 31579883; PMCID: PMC6743985.

(4) Morikawa D, Nojiri H, Itoigawa Y, Ozawa Y, Kaneko K, Shimizu T. Antioxidant treatment with vitamin C attenuated rotator cuff degeneration caused by oxidative stress in Sod1-deficient mice. JSES Open Access. 2018 Mar 13;2(1):91-96. doi: 10.1016/j.jses.2017.11.003. PMID: 30675573; PMCID: PMC6334861.

(5) Dincel YM, Adanir O, Arikan Y, Caglar AK, Dogru SC, Arslan YZ. EFFECTS OF HIGH-DOSE VITAMIN C AND HYALURONIC ACID ON TENDON HEALING. Acta Ortop Bras. 2018;26(2):82-85. doi:10.1590/1413-785220182602182353

(6) Fusini F, Bisicchia S, Bottegoni C, Gigante A, Zanchini F, Busilacchi A. Nutraceutical supplement in the management of tendinopathies: a systematic review. Muscles Ligaments Tendons J. 2016;6(1):48-57. Published 2016 May 19. doi:10.11138/mltj/2016.6.1.048

(7) Merolla G, Dellabiancia F, Ingardia A, Paladini P, Porcellini G. Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study. Musculoskelet Surg. 2015 Sep;99 Suppl 1:S43-52. doi: 10.1007/s12306-015-0364-1. Epub 2015 May 10. PMID: 25957549.

(8) Dougherty KA, Dilisio MF, Agrawal DK. Vitamin D and the immunomodulation of rotator cuff injury. J Inflamm Res. 2016;9:123-131. Published 2016 Jun 14. doi:10.2147/JIR.S106206

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. View Profile

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