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Rotator Cuff Tears

Rotator cuff muscles are responsible for the stability and function of the shoulder joint. The rotator cuff tendon attaches these four muscles to the humerus. This tendon can tear form its insertion site either from a single traumatic force or by continuous trauma of rubbing against the acromion bone (long term impingement). The most commonly injured tendon is the supraspinatous tendon. Symptoms of rotator cuff tear include pain in front or outside portion of the shoulder, radiating pain down to mid arm area, weakness and loss of strength in the affected arm, and night pain. Diagnosis is confirmed by a good quality MRI.

MRI Torn Cuff MRI Intact Cuff
MRI Torn Cuff MRI Intact Cuff

Treatment is initially aimed at reducing inflammation and restoring motion and strength similar to impingement syndrome. It is unlikely for a torn rotator cuff to heal itself, and it may even propagate and become larger. In younger individuals and heavy laborers, these tears are best treated by surgical fixation.

Arthroscopic View of Rotator Cuff Tear


Arthroscopic View of Rotator Cuff Tear

This involves shoulder arthroscopy and subacromial decompression (see above) followed by repair of the rotator cuff back onto its bony insertion. The bony attachment is usually performed with the use of metallic or absorbable anchors with permanent sutures.

Arthroscopic View of Sutures after Repair

Arthroscopic View of Sutures after Repair

X-ray showing Two Anchors

X-ray showing Two Anchors



Rotator Cuff Repair

X-ray with Anchors in Place

In the past, this procedure was performed via open surgery. This involved dissection through the fibers of deltoid muscle, which sometimes caused prolonged pain, loss of motion, and weakness. It also produced a relatively large scar. Today, almost all rotator cuff tears are repaired using arthroscopic technique with no dissection around the muscles and minimal scarring. Patients wear a sling for approximately four weeks while the rotator cuff heals and most patients return to good functional status within three months.

Rotator Cuff Repair

 

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