Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Partial tears may be treated without surgery by
placing your straight leg in a cast or immobilizer for four to six weeks.
Once you are able to raise the affected leg without discomfort for 10 days, it is safe to slowly stop the immobilization.
Treatment without surgery involves placing your foot so that the sole of the foot is pointed downward for
four to eight weeks.
This treatment has been advocated by some because it gives similar results to surgery in motion and strength. The problem with this treatment is that it has a re-rupture rate of up to 30%. Nevertheless, it may still be a reasonable option for those who are at increased operative risk because of age or medical problems or inactive people who may tolerate mild weakness in supporting weight on the ball of your foot (called plantarflexion).
The rotator cuff is unique because treatment
without surgery is the treatment of choice in most tendon injuries. More
than 90% of tendon injuries are long-term in nature, and 33%-90% of these chronic rupture symptoms go away without surgery.
In contrast, acute rupture, as occurs with trauma, may or may not be repaired surgically depending on the severity of the tear.
If the tear is either less than 50% of the cuff thickness or less than 1 cm in size, the dead tissue is removed arthroscopically. A small incision is made and a tool called an arthroscope is passed into the joint. Through it, the surgeon can see and remove dead tissue without actually cutting the joint open. The shoulder is then left to heal.
Most surgeons prefer not to operate on a ruptured biceps tendon because function is not severely impaired with its rupture.
Studies suggest that after biceps rupture, only a small fraction of elbow flexion is lost and approximately 10%-20% strength reduction in supination (ability to turn the hand palm up). This is considered to be a moderate loss and not worth the risk of surgery in middle-aged and older people.