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Is InSpace Balloon the Answer for Minimally Invasive Treatment of Massive Rotator Cuff Tears?

This week I sat in on a webinar with one of my favorite Physical Therapist Kevin Wilk. He is the Associate Clinical Director of Champion Medicine in Birmingham, AL, where he works with many professional and recreational athletes and orthopedic patients. He has published over 170 journal articles has written 115 book chapters and taught at over 900 professional and scientific meetings. He had Nikhil Verma, MD a nationally renowned orthopedic surgeon in Chicago, IL. The topic was "Advances in treatment and rehabilitation of rotator cuff: InSpace Balloons, SCR and more.

Did you know that Rotator Cuff procedures account for 550,000 surgeries in the United States? There are many people who are symptomatic but many who are not symptomatic with a rotator cuff pathology. One study mentioned was titled "Age-related prevalence of rotator cuff tears in asymptomatic shoulders." In this study of 411 asymptomatic volunteers, they found: 13% had tears in the 50-59-year-old group, 20% in 60-69 years old, 31% in 70-79 years old, and 51% in 80-89 years old. There are many reasons why someone may be symptomatic but why some tears limit function are often factors that can be addressed in physical therapy. The reasons why some tears limit function are 1. pain 2. compensatory muscle strength 3. location not size 4. Anterior/Posterior coupling (muscles). Medical Doctors and Doctors of Physical Therapy often use Treatment Algorithms. Following many criteria, a patient may be in one of these categories: Consider open reconstruction, arthroscopic reconstruction, indicate operative reconstruction, consider conservative therapy (PT) and repeat MRI after 1 year, and Consider partial repair/ margin convergence/ debridement/ tendon transfer to achieve asymptomatic tear.

One type of surgery with good outcomes that Dr Verma covered was Superior Capsular Reconstruction (SCR). This surgery is often used when the massive tear of the rotator cuff cannot be repaired. This surgery involves the reconstruction of the superior capsule in the shoulder joint which involves either an autograft (tissue from the same person) or an allograft (tissue from a donor). In July 2021 the FDA approved the InSpace balloon device for patients over 65 with no significant arthritis as a treatment option. One study in the Journal of Bone & Joint Surgery compared the InSpace implant to partial thickness repair for the treatment of full-thickness massive rotator cuff tears and found better outcomes, especially with range of motion (ROM) improvements.

Rehabilitation for a massive rotator cuff repair can be a long process. With the InSpace implant, Dr Verma's protocol is like this: Weeks 0-3: sling, Deltoid isometrics, passive/active assist range of motion. Weeks 3-10: discharge sling, active assisted range of motion to active range of motion as tolerated, begin deltoid re-education, anterior/posterior cuff strength. Months 3-12: Functional range of motion, functional strengthening focused on activities of daily living, light strengthening only! Transition to home exercises once painless and satisfactory function. To learn more, visit the InSpace Patient or Healthcare Provider websites.

I have worked for 20 years in physical therapy with patients who had no surgery and were able to rehabilitate without surgery to all repairs and surgical procedures (except the InSpace implant). I have worked closely with each healthcare team member including the surgeon, primary medical doctor, and others. If you have any shoulder pain, rotator cuff pathology, or pre and post-surgery, you are in good hands with me.

Karen Baltz Gibbs, PT, DPT, CSCS, CMP, LMT, Owner Garage Training & Rehab Gym

phone/text: 971-719-3162


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