Spin and the subacromial balloon spacer for massive, irreparable rotator cuff tears.

Spin plays a major role in tennis, basketball, baseball, golf, soccer, cricket, pool, bowling, ping pong, and all other ball sports.

Spin is achieved by applying an unbalanced force to the ball, causing it to rotate in the direction desired by the player.

In publications of clinical research on innovative treatments, positive spin is a frequent form of unbalanced reporting in which beneficial claims are overemphasized while negative findings are minimized, resulting in a biased conclusion that emphasizes the value of the intervention.

The authors of Evaluation of Spin in Reviews of Biodegradable Balloon Spacers for Massive, Irreparable Rotator Cuff Tears list 12 types of spin:

Abstracts are the part of publications most commonly read by surgeons. Spin is most problematic in abstracts, given their brevity and can result in the misrepresentation of a study’s actual findings. 

These authors conducted a search in the PubMed and Embase databases using the search terms: “subacromial balloon”, “subacromial spacer”, “rotator cuff”,  “irreparable”, “systematic review”, and “meta-analysis.” 

A total of 29 studies met their inclusion criteria, of which 10 were reviews or meta-analyses and the remaining 19 were primary studies. The majority of included studies were classified as level IV evidence and only one RCT met this study’s inclusion criteria. 

Spin was highly prevalent in the abstracts of primary studies, systematic reviews, and  meta-analyses discussing the use of the subacromial balloon spacer in the treatment of massive, irreparable rotator cuff tears: spin was identified in 27 of the 29 studies ( 93.1%). Below is a list of the types of spin re-ordered by frequency of occurrence in publications on the subacromial balloon.

Spin commonly served to promote the clinical successes of balloon spacer implantation, often by overlooking confounding factors that may question the accuracy of a study’s findings as shown in the two most frequent types:

Type 3 spin, “Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention”

Type 9 spin, “Conclusion claims the beneficial effect of the experimental treatment despite reporting bias”.

Comment:  To date, there is a lack of high-quality evidence demonstrating superiority of the subacromial balloon spacer in treating massive irreparable rotator cuff tears. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. found that débridement alone outperformed the subacromial balloon spacer for the treatment of these tears.

Similar frequencies of spin are likely to be found in abstracts regarding most other orthopaedic interventions.

Analyzing Spin in Abstracts of Orthopaedic Randomized Controlled Trials With Statistically Insignificant Primary Endpoints found an incidence of 44%.

Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction found least 1 form of spin in all 17 qualifying studies. The most common types of spin were type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") and type 9 ("Conclusion claims the beneficial effect of the experimental treatment despite reporting bias"), both of which were observed in 11 studies (65%). A statistically significant association between lower level of evidence and type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was observed. Interestingly, The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining

Readers, reviewers, authors and editors need to be alert to spin in reports of research and consider its presence in efforts to optimize the literature and in the interpretation of current publications, especially those concerning new technologies.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).

Spinning the data on the value of glenoid augmentation - a guide for authors of systematic reviews and meta-analyses

In the previous post we discussed the challenges in doing clinically significant research on shoulder arthroplasty.

As a follow-on, here we focus on the importance of the way research is presented, with particular reference to spin – defined as bias that overstates efficacy and/or underestimates harms of a treatment. Systematic reviews and meta-analyses are at risk for spin if there was bias in the primary studies on which they were based. 

There is the potential for spin in any presentation of outcomes. Evaluation of spin in reviews of biodegradable balloon spacers for massive irreparable rotator cuff tears found that 93.1% of the 29 included studies had at least one type of spin. See other examples of spin in our literature on this post. 

A recent article provides a useful guide to the elements of spin and how to avoid them.

The authors of Evaluation of Spin in Systematic Reviews and Meta-Analyses Involving Glenoid Augmentation in Total Shoulder Arthroplasty assessed the quantity and types of spin in systematic reviews and meta-analyses of glenoid augmentation in shoulder arthroplasty. They searched for each of 15 types of spin (see A new classification of spin in systematic reviews and meta-analyses was developed and ranked according to the severity). At least one form of spin was identified in 13 (81.3%) of the 16 studies. 

“The conclusion claims the beneficial effect of the experimental  treatment despite a high risk of bias in primary studies” was the most commonly occurring type of spin in this review; it is found in many previous studies in other orthopaedic literature, ranging from 23.1%-65%. A common weakness contributing to this type spin was drawing conclusions based on primary studies of low levels of evidence

‘‘Conclusion claims the beneficial effect of the experimental treatment despite reporting bias’’ was the next most common; which may mislead readers by the selective inclusion and omission of results in the abstract. Reporting bias results from the tendency to overreport or selectively publish positive results. One example of reporting bias can be seen in a recent article that concluded that the reverse shoulder arthroplasty “provided highly favorable results” but only reported the statistically significant improvement in Constant scores and omitted the lack of statistically significant improvements in VAS, ASES,  SST, and functional range of motion measurements. 

The 15 types of spin are listed here as a heads up for surgeons considering publishing a systematic review. 

The title claims or suggests a beneficial effect of the experimental intervention not supported by the findings 

Authors hide or do not present any conflict of interest 

Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention 

Selective reporting of or overemphasis on harm outcomes or analysis favoring the safety of the experimental intervention 

Failure to specify the direction of the effect when it favors the control intervention 

Failure to report a wide confidence interval of estimates 

The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies – Most common 43.8 % of the glenoid augmentation studies.

The conclusion claims the beneficial effect of the experimental treatment despite reporting bias. Second most common (37.5% of the glenoid augmentation studies.).

The conclusion formulates recommendations for clinical practice not supported by the findings 

The conclusion claims safety based on non-statistically significant results with a wide confidence interval 

The conclusion focuses selectively on statistically significant efficacy outcome 

The conclusion claims equivalence or comparable effectiveness for non-statistically significant results with a wide confidence interval 

The conclusion extrapolates the review findings to a different intervention (e.g., claiming efficacy of one specific intervention although the review covered a class of several interventions) 

Conclusion extrapolates the review's findings from a surrogate marker or a specific outcome to the global improvement of the disease 

Conclusion extrapolates the review's findings to a different population or setting 

The authors also applied A Measurement Tool to Assess Systematic Reviews (AMSTAR 2), a questionnaire that quantifies the quality of a systematic  review based on criteria such as whether authors reported presence of bias, impact of bias, the use of a predetermined protocol, funding sources, and conflicts of interest, and/or adequately characterized studies included in the review. Based on this review three (18.8%) of the studies were related as "moderate" quality and the remaining thirteen (81.3%) were rated as "low" quality. None met the criteria for "high" quality.  The elements of the AMSTAR 2 are shown below

Did the research questions and inclusion criteria for the review include the elements of PICO (Patient, Population, or Problem; Intervention; Comparison; Outcome)? 

Did the report of the review contain an explicit statement that the review methods were established before the conduct of the review, and did the report justify any significant deviations from the protocol?
Did the review authors explain their selection of the study designs for inclusion in the review?
Did the review authors use a comprehensive literature search strategy?
Did the review authors perform study selection in duplicate?
Did the review authors perform data extraction in duplicate?
Did the review authors provide a list of excluded studies and justify the exclusions?
Did the review authors describe the included studies in adequate detail?
Did the review authors use a satisfactory technique for assessing the risk of bias in individual studies that were included in the review? 

Did the review authors report on the sources of funding for the studies included in the review?

The authors also found a statistically significant association between the presence of a conflict of interest and the lack of reporting funding sources. These conflicts included examples of all of the following: authors who reported receiving grants, personal fees, royalties, and research fees from orthopedic device manufacturers, as well as authors who were investors, presenters, or consultants for orthopedic device manufacturers.

They concluded  that “Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses studying glenoid augmentation with TSA. Misleading reporting is the most common category of spin.“

 

We want our publications to be as useful and as transparent as possible. Hopefully, this guide will help us avoid spin when we present our work.

Bullock's Oriole

Umtanum Washington, 5/25/25

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).

Stemless total shoulder - is there spin in the abstracts?

Recently I've posted on 

Spin in abstracts on the subacromial balloon

Spin in abstracts on the augmented glenoid

Spin in abstracts on superior capsular reconstruction

Now we have the opportunity to consider spin in abstracts on the stemless total shoulder arthroplasty 

The stated goal of Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses of Stemless Total Shoulder Arthroplasty was to identify and detail incidence of spin in the abstracts of systematic reviews and meta-analyses of stemless component total shoulde arthroplasty (TSA). The secondary goal was to investigate general study characteristics and describe patterns in relation to spin.

The authors point out that surgeons tend to read only the abstracts of publications, thus assessing spin in abstracts is important.

The details of their analysis is similar to that presented in Spin in abstracts on the augmented glenoid.

Basically the types of spin are:

Authors hide or do not present any conflict of interest 

Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention 

Selective reporting of or overemphasis on harm outcomes or analysis favoring the safety of the experimental intervention 

Failure to specify the direction of the effect when it favors the control intervention 

Failure to report a wide confidence interval of estimates 

The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studiesThe conclusion claims the beneficial effect of the experimental treatment despite reporting bias. 

The conclusion formulates recommendations for clinical practice not supported by the findings 

The conclusion claims safety based on non-statistically significant results with a wide confidence interval 

The conclusion focuses selectively on statistically significant efficacy outcome 

The conclusion claims equivalence or comparable effectiveness for non-statistically significant results with a wide confidence interval 

The conclusion extrapolates the review findings to a different intervention (e.g., claiming efficacy of one specific intervention although the review covered a class of several interventions) 

Conclusion extrapolates the review's findings from a surrogate marker or a specific outcome to the global improvement of the disease 

Conclusion extrapolates the review's findings to a different population or setting 

The authors analyzed 12 articles. At  least 1 form of spin was observed in 10/12 (83.3%) studies. The most common type of spin was

“The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies”, which was found in 7/12 (58.3%) studies. 

The three other common types of spin identified were

"The conclusion claims safety based on non-statistically significant results with a wide confidence interval"

"Authors hide or do not present any conflict of interest" 

"The conclusion formulates recommendations for clinical practice not supported by the findings"

According to  AMSTAR 2, 11/12 (91.7%) of studies had confidence ratings of “low” or “critically low” due to one or more critical flaws.

The authors concluded that "spin is prevalent in abstracts of systematic reviews and meta-analyses covering stemless TSA. Reporting more favorable outcomes is the most common type and physicians should be aware of this when making clinical decisions based on research". Authors tended to neglect the evaluation of primary study bias in their methodology; instead the discussion focused mainly on advantages of the stemless design.

Risk of overestimating the clinical importance of the stemless component TSA due to spin is especially relevant when contextualized within current literature on the topic. Romeo et al and Wiater et al recently performed two large, multicenter, prospective, blinded randomized controlled trials evaluating short-term clinical and radiographic outcomes of stemless implants against their traditional stemmed counterparts. Both studies found a lack of significant difference between stemmed and stemless component clinical outcomes, complications, and reoperation rates within a 2-year follow-up period. Additionally, the authors were careful to describe stemless implant performance as “noninferior,” “safe,” “effective,” or “promising.”Their findings are in contrast to the beneficial effect spinning that was most pervasive across the systematic reviews analyzed in the current study and suggest a pattern of overly optimistic conclusion-drawing despite RCTs that do not yet paint such a positive picture of the stemless technology.

Conclusion:

This study does not provide new evidence of the case for or against the use of a stemless humeral component. It does suggest that authors should attempt to avoid spinning their abstractions by making sure that the conclusions regarding safety and clinically (not only statistically) significant benefit are supported by robust evidence and that conflicts of interest and other sources of bias are made explicit.

Spin is not always bad, here are male and female redtail hawks spinning in courtship.

Red tailed hawks courting

Union Bay Natural Area

March 2021

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link

Follow on twitter/X: https://x.com/RickMatsen
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).

Superior capsular reconstruction - osteolysis, cost, retears and bias in systematic reviews

Superior capsular reconstruction - some recent articles.

Acromial and humeral head osteolysis following superior capsular reconstruction using autologous tensor fascia lata graft

These authors reported the occurrence of acromial and humeral head osteolysis after superior capsular reconstruction (SCR) using autologous tensor fascia lata graft. In 57 patients with a minimum followup of 2 years, 35.1% (20 of 57 cases) demonstrated osteolysis: acromial osteolysis in 7, humeral head osteolysis in 3, and acromial and humeral head osteolysis in 10). 

Compared with the group with no osteolysis, the osteolysis group were not noted to have inferior clinical outcomes or higher graft tear rates. 

Classification system of graft tears following superior capsule reconstruction

These authors evaluated graft integrity after superior capsular reconstruction in 42 patients at a mean of 14 ± 7 months. MRIs demonstrated graft failure in 26 (62%) of the shoulders. Of the 26 graft tears, 14 (54%) were from the glenoid, 5 (19%) mid-substance, 6 (23%) from the tuberosity, and 1 (3.8%) had complete graft absence.

graft intact (upper left), graft tear from glenoid (upper right), mid substance tear (lower left), graft tear from tuberosity (lower right).

Cost comparison and complication profiles of superior capsular reconstruction, lower trapezius transfer, and reverse shoulder arthroplasty for irreparable rotator cuff tears

These authors assessed the cost, complications, and readmission rates of three common surgical treatment options for IRCTs: superior capsular reconstruction (SCR), arthroscopically assisted lower trapezius tendon transfer (LTTT), and reverse shoulder arthroplasty (RSA). The cost analysis included a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation.

With the numbers available, differences among the 3 surgical procedures with respect to complication (P = .223), reoperation (P = .999), and readmission rates (P = .568) did not reach statistical significance. The mean standardized costs for the treatment of 3 common IRCT procedures inclusive of 60-day workup and 90-day postoperative recovery were $16,915, $17,210, and $20,837 for LTTT, RSA (average added cost $295), and SCR (average added cost $3922), respectively. 

Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction

"Spin" is the reporting of data in a manner that emphasizes beneficial effects or deemphasizes negative effects despite insufficient evidence to support those conclusions.  Spin has been separated into 3 categories: misleading representation, misleading reporting, and inappropriate extrapolation.

This study’s primary objective was to identify, describe, and account for the incidence of spin in systematic reviews of superior capsular reconstruction SCR. At least 1 form of spin was observed in all 17 studies meeting the inclusion criteria.

The most common types of spin were ‘The conclusion claims the beneficial effect of the experimental treatment  despite a high risk of bias in primary studies’’ and ‘‘Conclusion claims the beneficial effect of the experimental treatment despite reporting bias’’, both of which were observed in 11 studies (11 of 17, 65%). 

A statistically significant association was observed between lower level of evidence and ‘The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies’’.

A statistically significant association was also found between more recent year

of publication and the spin category misleading interpretation.

The authors concluded that spin is highly prevalent in abstracts of SCR systematic reviews and meta-analyses. An association was found between the

presence of spin and lower level of evidence, year of publication, and lower ratings of study quality.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

Rotator cuff repair - a patient's perspective on what to consider before and after surgery

This week I received this note from a patient over one year after the open rotator cuff repair performed without acromioplasty.

“You were in my thoughts today as I was swimming laps. Thank you, so very much, for repairing my shoulder and giving me back the simple pleasure of a good nights' sleep and being able to swim pain free.”

I asked the patient if she’d be willing to send me some of the lessons she learned about cuff surgery from the perspective of the patient. Here’s what she sent verbatim.

Rotator Cuff Surgery – Patients Lessons Learned

Before Surgery:
Don’t ask your doctor to drive because they have to say no if you are on pain drugs. If you ignore the warning and drive under the influence, you might want to have a good attorney lined up before surgery.
Transportation – explore public transit. Request a temporary Paratransit pass if there is no local public transportation. It may take a couple months to obtain the pass or to become knowledgeable with the public transportation system. Its fun to explore the system while you are recovering (be positive – it’s an adventure and better than watching TV).
Training – hit the gym and/or PT to strengthen your upper body and core because you will not have the use of your surgical side. That means the other shoulder will be getting a lot of use. The last thing you need is to damage the good side with over exertion.
Beds – you will want to sleep upright because laying down means your shoulder is touching the bed and it hurts. Some people sleep in chairs while others use a mountain of pillows in bed ….ALONE. This means you need to reassign beds so that you can sleep alone. (see pet care)
If the surgical side is your writing hand, then start figuring out what you need to do to complete the task when you cannot write. This may mean paying forward on bills or setting up online payments and getting written tasks completed early.
Practice being one handed for the month prior to surgery (use the non-surgery side and no cheating). Every time you find yourself needing to use the other hand, stop and figure out how you will do that task after surgery when you cannot use the surgical side.
Shower set up – Can you reach the soap and shampoo? Can you dispense the product with one hand? Pump bottles on the shower floor were easier than on the rack. Long handled shower brushes help in reaching back areas.
Replace large bath sheets with a stack of small hand towels (easier to control one handed).
Longer shower time – particularly if you have long hair – may result in changing your daily schedule. Plan on draining the hot water tank.
Figure out how to deal with long hair. Be sure to teach your partner how to tie a pony tail before surgery. Who would have known that doubling an elastic on a ponytail is like a rubrics cube puzzle to some men?
Pedicures/Manicures – both sexes. Dealing with nail hygiene is best done by someone else until you regain the ability to do it yourself.
Bathroom habits. Awkward to difficult, more so for women. Baby wipes are a good thing. Changing toilet paper rolls provides entertainment.
Dental habits: Awkward at first. Stock up on the dental floss sticks that facilitate one handed flossing.
Medicine bottles cannot be opened one handed, so ask your pharmacist to provide easy open tops instead of child proof tops. If you have young children or animals, keep the meds out of reach (may require re-arranging cabinets).
Cortisone cream – have a tube handy because the pain narcotics can cause itching.
Bandages/Plastic Wrap/Packing Tape – Get lots of big (3x5 or larger) bandages to cover the wound and return any boxes that are not used. Plastic Wrap and Packing Tape is used for post surgical showers for two weeks.
Shoes - Slip on shoes are the “it” thing until the pain subsides. Eventually you will be able to dangle and tie by pulling the laces with the non-surgical side to avoid loading the surgical repair.
Forget bras until the pain subsides. Strapless bras work but be sure to teach your partner how to fasten them (yeah, it’s different than undoing them – it takes much longer and may require the use of glasses). Slip on sports bras are out for months. If you are alone, you can fasten the bra before stepping into it and pulling it up one handed (maybe but not likely if you are petite). Don’t do anything that could cause a fall.
Shirts – nothing tight can be worn because you cannot squirm into it with rotator cuff surgery. And even if you can get it on via dangling and perseverance, you will end up cutting it off. Remember you will not be wearing a bra, so nothing too thin or revealing. By now, women are beginning to realize that guys are getting a much easier deal with rotator cuff surgery. The surgical site is sensitive so find soft clothing. Half zip shirts seemed to work well. Buttons are a nuisance and cause delays.
Forget anything with zippers for the first six weeks. The last thing you need is to be dancing in a toilet cubicle with your legs crossed, carrying a pillow under your surgical arm and fighting with a stuck zipper.
Cool weather and rain demand additional layers. Nothing too bulky will fit into the sling, so plan for something thin while providing warmth and waterproof. Forget umbrellas.
Prepare two months of food for the freezer – soups, casseroles, etc. Individual servings are easiest. Freeze pizza slices. Make hamburger patties and freeze on a sheet before placing into zippered storage bags.
Pop top cans can be managed by placing in a drawer, held shut with a hip to hold the can, and then the good hand can remove the top. Can openers are out, electric can openers are good.
Kitchen equipment – Le Crueset cast iron dutch ovens require two hands (trust me). Suggest purchasing some inexpensive handled pots until you have the use of two hands. Draining food (potatoes, pasta, etc) requires a strainer in the sink. Slicing and dicing requires impossibly sharp knives (some grocery stores do knife sharpening for free – ask at the meat counter). A Cuisinart is very helpful for one handed food preparation. Otherwise, purchase pre-sliced vegetables. A milk pitcher is a necessary luxury unless you can one arm a gallon milk jug. Move dishes to easy access shelves. Straws are useful even to drink hot beverages because they allow for one handed multi-tasking.
Microwave. You no longer have two hands to hold hot items. Be sure to practice one handed use beforehand!
Phones – a phone with speaker is useful because it allows for one handed multitasking.
Flashlights - replacing batteries one handed in the dark is tough. Suggest taking care of it (flashlights, smoke detectors, remote controls, etc) before you have surgery.
Laundry – stock up on detergent with easy pour lids and not too big a bottle since its one handed. Laundry baskets that can withstand being punter kicked through the house (you aren’t to be lifting or bumping that shoulder).
Making beds – nearly impossible but preferably this task will be done by someone else.
Washing floors & Scrubbing Tubs & Vacuuming – can be done while doing your dangling exercise provided you don’t move your dangling arm. Preferably done by someone else (forever). Be careful not to trip, slip or get knocked.
Pet Care –
Take care of planned vet visits before surgery (well checks, dental, shots, etc). Be sure to get a supply of routine medical stuff like ear cleaning solution, pain med, etc to avoid making trips to the vet when you are not able to drive much less manage a sick animal.
Care – how do you plan on exercising your energetic best friend while in pain and one handed? This one takes a bit of planning and time, so start the minute you know that you need surgery. Hunting collars [http://www.lcsupply.com/Tritronics-Classic-70-G3-EXP-Collar/productinfo/C70/] are a great tool for leash free walks! Strongly recommend working with a dog trainer on the proper use of hunting collars though because incorrect usage is cruel. Find places to walk that are free of trip hazards and other uncontrolled dogs. The last thing you need is to have a large dog jump on you.
Food – stock up for two months. Pop top cans are best. How will you lift a 30 lb bag of dog food for the next eight months?
Sleeping arrangements – your best friend knows something hurts and will want to provide comfort (particularly when you are awake all night in pain). Trust me on this – having a 50 lb dog leaping into your lap or onto the bed is NOT a good thing according to the neighborhood that was awoken from their sleep. Figure this out before surgery!

After Surgery
Driving – your doctor has told you not to drive for several reasons. It’s illegal if you are taking pain meds. Your shoulder will atrophy before or beginning at surgery. That means the strong muscles are not able to protect your repaired shoulder and it becomes progressively easier to damage the repair and further damage your shoulder because the muscles are not there to protect it. A damaged repair may not be able to be repaired again and who wants to go through the pain, suffering and frustration twice???
Pain – you will have pain but it varies in intensity with every patient. Plan on not sleeping the first few nights and stay on top of your pain meds.
Have some movies and books handy. A single handle basket with phone, books, Kleenex, water bottle, snacks, etc is handy to easily take everything you need as you move about the house.
Sling/Immobilizer – is awkward but necessary to protect your shoulder. Every bump in the road will be felt. Be prepared to have people want to provide well wishes by patting you on the shoulder and giving hugs – shoulder surgery is a full contact sport and its very painful. The sling/immobilizer will become your friend when you are dealing with the public. Turn away from oncoming hugs!
Resuming Sex? – Not early in the healing. No easy answer on this full contact sport. It’s a long time though… a long, lonely time.
Gym – get back to the gym as soon as you are off pain meds to ride the spin bike, and walk on the treadmill. Do the shoulder dangles prescribed by the PT. Work out a training plan with your physician and PT to avoid re-injuring your shoulder while maintaining your mental and physical conditioning.
Gardening – Nothing bigger than one handed light weeding while sitting using small hand tools. No heavy lifting. Do not trip. No falling.
Painting – actually not a bad activity once the pain leaves and there is no chance of falling/bumping or otherwise disturbing the repaired shoulder.
Salads – it’s almost impossible to toss a good salad one handed.
Eating out – if its one handed on your weak side, be prepared for messy eating. My dog is gaining weight by just following me around the house.
Frustration – rotator cuff surgery is 90% mental toughness. Be prepared to have frustration meltdowns because the healing time is so long and painful. Tell your friends, family and physician if you are frustrated or overly emotional – don’t feel the need to tough it out alone. You are grieving the loss of your independence.
You will learn to ask for help from strangers and it’s an opportunity to meet some really nice people that you might have otherwise not met.
Hope – know things will get better and take one day at a time. It takes about a year to feel normal.

===
Consultation for those who live a distance away from Seattle.

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Does PRP help patients having rotator cuff repair?

Platelet-rich plasma in fibrin matrix to augment rotator cuff repair: a prospective, single-blinded, randomized study with 2-year follow-up

These authors point out that "despite improvements in the mechanical constructs used to repair rotator cuff tears, retear remains a significant issue. Retear rates ranging from 10%-90% depending on the size of the tear, age of the patient, amount of fatty infiltration, and type of repair have been reported. Higher failure rates in patients older than 65 years have been consistently demonstrated".

They sought to test the concept that application of autologous platelet-rich plasma in fibrin matrix (PRPFM) improves clinical outcomes in patients undergoing arthroscopic rotator cuff repair using a prospective, randomized, single-blinded study of 76 patients. The treatment group underwent arthroscopic rotator cuff repair with PRPFM. 

The control group did not receive the PRPFM. 

The Simple Shoulder Test scores showed no incremental benefit of PPFM: the improvement was from 45% to 96% for the control group and from 49% to 96% in the PRPFM group. 

Strength of the supraspinatus at 24 months by dynamometer testing was 99.8% in the control group and 96.3% in the PRPFM group. Infraspinatus strength was 104% in the control group and 103% in the PRPFM group

MRI's suggested a 19% retear rate for the control group and 7.4% for the PRPFM technique at 6 months.

All of their results showed no statistically significant benefit of PRPFM.

Comment: This is a valuable randomized trial that shows that showed no evidence of added clinical benefit for the PRPFM. If the study had not included the control group, one might conclude that cuff repair with PRPFM argumentation was a "clinically viable technique" because the patients were improved. However, with the inclusion of the control group, it became evident that the addition of PRPFM did not benefit the patients.

It is of interest that in spite of the apparently greater rate of retears in the control group, there was no difference in clinical outcomes.

The authors do not provide the incremental time involvement and the incremental cost of the PRPFM approach (see the details at the end of this post below).

In any event, evidence of incremental value for PRPFM was lacking.

Preparation of PRPFM: "Eighteen milliliters of whole blood was drawn from patients by use of sterile technique, transferred to a specially designed tube for centrifugation in a Drucker 755VES general-purpose centrifuge,

and spun for 6 minutes at 1100 RPM. During centrifugation, the heavier red and white blood cellular components moved to the bottom of the tube while the lighter platelets remained at the top in the plasma. A polyester separator gel in the tube sealed the red blood cells and the white blood cells to prevent contamination with the platelets. After processing, 4-4.5 cm3 of leukocyte-poor PRP was transferred to 2 separate tubes containing trace amounts of calcium chloride to replace the calcium that was bound by the citrate and was spun for an additional 15 minutes at 1450 RPM. This second, faster spin using the same centrifuge caused the fibrinogen in the plasma to form a 2-cm3 solid PRPFM in disk-like form. The PRPFM was then removed and fashioned on the back table to fit the size and shape of the tear.


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