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Improved Healing Rates for Challenging Rotator Cuff Tears Available Now

As highlighted in a recent article in the Wall Street Journal, Maria Sharapova prevailed at the 2012 French Open Tennis Tournament for her first French Open Title and a Career Grand Slam. Her performance is even more remarkable when we learn that just a few years ago she wasn’t even sure whether she would be able to continue playing tennis. Her story offers some important lessons for anyone suffering activity limiting shoulder pain. We are told that when she started to have shoulder pain, she saw several doctors that reviewed an MRI of her shoulder and felt that perhaps she just had inflammation. This, unfortunately, is an all too common scenario that many patients experience daily- tests are often ordered with only a cursory or ineffective history and physical exam. Along with not helping to establish the real diagnosis, another more worrisome scenario with this practice is that it can lead to unnecessary shoulder surgery. As in Maria Sharapova’s case, her pain persisted and became increasingly severe until a repeat MRI revealed a rotator cuff tear requiring surgery. The possibility remains that a detailed history and physical by a shoulder specialist that values these critical tenets of patient care could have allowed her to avoid continued damage to the shoulder avoiding surgery. The other and more common scenario we see in patients with failed shoulder surgery is that the MRI reports a tear and shoulder surgery is performed without any true clinical correlation. The consequences of both a false negative and false positive diagnostic test such as the MRI without real clinical correlation can be very expensive and frustrating for patients.

When Maria Sharapova needed shoulder surgery in 2008, she asked a lot of questions. Which other athletes had undergone the procedure? What about tennis players? How many of them came back to play as well as they had played before?

“I didn’t get many answers back, which was a little frightening,” she said …

Sharapova won the U.S. Open in 2006 and the Australian Open in 2008, and she reached No. 1 in the world four different times, but only stayed there for a total of 17 weeks. Even if she had remained healthy, she wasn’t built to dominate. And then her shoulder started to hurt, and she couldn’t figure out why. Doctors who looked at an initial MRI said they saw nothing and that she was suffering from inflammation.

The pain persisted, and by the time Sharapova played a first-round match in Montreal in July 2008, it had become severe. After winning in three sets and withdrawing from the tournament, she took another MRI that evening and flew to New York to meet David Altchek, a doctor at the Hospital for Special Surgery. He met Sharapova at the airport, his computer in tow, and examined her most recent images. He had bad news: Sharapova had two tears in her rotator cuff.

Sharapova unsuccessfully tried to rehab the injury and then underwent surgery in October. She didn’t play competitively again until March 2009, when she entered the doubles tournament in Indian Wells, Calif. Her shoulder still hurt, and another MRI revealed a bone bruise. She rested, found a new physical therapist and finally returned to singles in May in Poland. Her second tournament came at the French Open, where she reached the quarterfinals.

It was a fast start, but then Sharapova stalled. She wouldn’t reach a Grand Slam quarterfinal again until the 2011 French Open.

“It took a lot of time, it took a lot of bad losses, it took a lot of bad days. It certainly didn’t come easy to me,” Sharapova said. “I was grumpy, and I had my tough days, and I would yell at people and say, ‘You’re promising one thing and it’s not happening.’ I would certainly have my doubts, but I kept going, and I didn’t let anybody tell me otherwise.”

Sharapova’s stubbornness was clear from the beginning. But it’s resilience that has become her defining characteristic. In that sense, she is among the most unique tennis prodigies of all: one who still loves the sport—and she says she’s not close to finished yet. “There’s nothing in the world that gives you that adrenaline, just being in the moment of a match,” she said. “There’s nothing in my life that’s given me that experience.”

It is also important to recognize the importance of having an experienced team of specialists-surgeon, trainer, therapist, coach, etc.-helping with our recovery, because as Maria Sharapova’s story demonstrates, recovery is a long and slow process that without the right guidance can be derailed easily. Another source of significant frustration for patients can be the relatively high failure rate of rotator cuff repair. As the field of shoulder surgery continues to evolve, we are helping to develop better and less invasive techniques that hold the promise of significantly improved healing rates for challenging rotator tears.

Vivek Agrawal, MD

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