Shoulder surgery

Hi Joe, well, you asked a question I am very curious about, since I have several repairs in the healing stages now after rotator cuff surgery, "...I just don't understand why, in general, surgery on soft tissue in the shoulder is so difficult to treat successfully. Does anyone have any insight into this?"
You must know by now know that I am sort of a research nerd, and I did look into this before I proceeded with surgery.
Here is an excellent paper on the issue:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7307866/
One of the most informative paragraphs says: "...In cases of extra-articular tendon and ligaments that have the capacity to heal, the surgeon will reconnect or re-attach the torn tendon and ligament. These procedures usually result in the formation of inferior scar tissue which is more prone to re-rupture..."
The entire paper is more discussion about emerging knowledge of how ligaments and tendons repair themselves (not very well - lots of scar tissue) and advances in stem cell and adjunct therapies (still in early stages.)

I had a donor grafted ligament inserted in my knee nearly 40 years ago (I did not have a suitable one of my own) and the surgical understanding at the time was that it would "probably" last 15 years or so. But, the surgeon recommended early complete rest (6 weeks) to allow the healing to begin, followed by long, progressive PT and strengthening (almost 6 months.) Now in my 70's that knee is still going strong.

Recently, I had complex rotator cuff & biceps tendon repair, along with debridement of many bone spurs, done by a highly recommended surgeon. His healing protocol is similarly strict, with immobilization for 6 weeks, and no PT except very basic mobilization exercises until 8 weeks, to allow time to heal. In addition, according to the Doctor of Physical Therapy I am now seeing, his PT approach is "beyond ultra-conservative." But, unlike the typical 30-50% failure rate for rotator cuff surgery, his is below 10%. So at 4 months, I am just beginning to push my range of motion, and strengthening is done with isometrics and no weights. The DPT is not convinced this is a good protocol, but he says "we can't really with his success rate."

So I am very hopeful that this conservative approach is allowing for proper healing of the repaired tendons. I do know that the enforced rest has allowed healing of some of the tears in my trapezius and pectoralis muscles.

Just as an aside - other soft tissue tears such as the labrum in the hip are equally resistant to successful surgical repair.

Good luck with you hip - mine are still dong great after almost 14 years - I think my knees might be next up, but I am trying for a surgery-free year in 2025.

I would be considered petite and had a shoulder replacement in 2018. I also have a golf ball sized muscle which is painful when I need to use it. Kind of tenses up so I have to stop doing what I was doing. I had hoped there was a way to remedy this but the surgeon said there isn't. He is a very highly recommended surgeon for this type of surgery.

Thank you for your response! God bless you!!

Thank you! God bless you!!

@lightluz My SLAP tear was a lot of years ago, so I have recovered without surgery. Since then, I had cervical spine surgery for a ruptured disk and spinal cord compression.

@jenniferhunter Wow !!!! You have gone through a lot!! I guess related to pain and recovery has to be kind of the same. So sorry

@lightluz My issues were related to injuries. I caused the SLAP tear but reaching behind me to the back seat in the car and yanking on something I was trying to retrieve and I got a sharp pain in my shoulder. I had a whiplash during a traffic accident that years later caused a herniated disc eventually needing surgery. My ankle fracture was from falling off a spooked horse that was bolting. Sure, I’d be better if none of that happened, but I accepted the challenges of recovering and thriving afterwards. I’ve moved on from it, but sharing my experiences helps others. I guess I feel lucky that these injuries were not worse.