Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Tuesday, August 19, 2008
Figure 1 - Rotator cuff, viewed from above Rotator cuff – normal rotator cuff attachment around the humeral head Rotator cuff – small rotator cuff tear Rotator cuff – large rotator cuff tear Rotator cuff – large rotator cuff tear with poor quality tissue Rotator cuff – large rotator cuff tear with early cuff tear arthropathy Rotator cuff – irreparable rotator cuff tear Rotator cuff – massive rotator cuff tear with rotator cuff tear arthropathy Rotator cuff – rotator cuff tear arthropathy Rotator cuff – rotator cuff tear arthropathy with collapse of the humeral head SummaryOverview
The rotator cuff is a group of four tendons that blend together to
help stabilize and move the shoulder. Each of the four tendons connects a muscle
originating on the shoulder blade (scapula) to part of the upper part of the
arm bone (humerus). The names of these muscle-tendon components of the rotator
cuff are:
- the supraspinatus,
which runs over the top of the ball of the shoulder joint (humeral head);
- the subscapularis,
which runs across the front of the humeral head; and
- the infraspinatus
and the teres minor, which run across the back of the humeral head.
Tears in the rotator cuff result from a combination of injury and
weakening of the tendon from wear and tear, disuse, repeated use of steroid (cortisone)
injection, and smoking. The extent of injury necessary to tear the cuff depends
on the quality of the tendon. Young, healthy rotator cuff tendon is almost
impossible to tear. However, older, multiply injured, multiply injected tendons
or tendons in a smoker may tear with no injury at all. Tears in younger
individuals are more likely to extend only part way through the tendon (partial
thickness tears). Tears in older individuals are more likely to tear completely
through the tendon (full thickness tears) and to involve multiple tendons.
Rotator cuff tears range from small to massive. Here is a gallery of
rotator cuff pathology:
- Small tear
involving the supraspinatus tendon only
- Large tear involving the supraspinatus and
infraspinatus
- Large rotator cuff tear with poor quality tissue
- Large rotator cuff tear with early loss of the
cartilage of the humeral head (rotator cuff tear arthropathy)
- Large rotator cuff tear that is not reparable
- Massive rotator cuff tear with rotator cuff tear
arthropathy
- Complete failure of rotator cuff with rotator
cuff tear arthropathy
- Rotator cuff tear arthropathy with collapse of
the humeral head
The types of injuries most likely to cause cuff tears are those in
which the elevated arm is forced downward (an eccentric force) or when the
shoulder attempts a sudden, jerky lift (a concentric force).
Full thickness tears do not heal by themselves because the muscles
pull the edges of the tear apart. However, it is possible for full or partial
thickness tears to stabilize, leaving the shoulder with reasonable comfort and
function.
The more force necessary to produce a tear, the more likely it is that
the tear will be surgically repairable. Healthy tendon requires a major force
to tear it. Tears resulting from major injury can usually be repaired
successfully if surgery is not delayed more than several weeks.
Weakened,
degenerative cuff tissue is more easily torn, even by normal activities.
Durable repair of these tears may not be possible because of the lack of
sufficient quantity and quality of tendon tissue. For these reasons, patients
should seek prompt evaluation of shoulder weakness by an experienced shoulder
surgeon, especially if the weakness comes on suddenly, or after an injury.
A surgeon experienced
in shoulder surgery can repair a rotator cuff tear if there is enough good
quality tendon tissue.
Repair of Rotator Cuff Tears
Surgery for rotator cuff tears at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment.
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