Massive Retracted Rotator Cuff Tear

What is the Rotator Cuff?

The rotator cuff consists of 4 muscles which stabilise the shoulder joint and enable certain arm movements. The muscles of the rotator cuff include:

• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

Tendons of the rotator cuff muscles are attached to the head of the humerus (upper arm bone) securing it within the glenoid cavity of the shoulder blade to form the main shoulder joint.

What are Massive Rotator Cuff Tears?

A tear in the rotator cuff can cause pain and disability. It can occur from degeneration of the rotator cuff due to overuse or from a sudden injury. Massive rotator cuff tears involve tears in two complete tendons of the rotator cuff. A tear of more than 5 cm is described as massive. A massive tear may be associated with degeneration and retraction of the tendon and can be difficult to repair if treatment is delayed.

Causes of Rotator Cuff Tears

The common causes for a tear in the rotator cuff include:

• A blow or injury to your shoulder
• Sudden excessive loading of the joint such as while lifting an object
• Sports such as baseball and tennis which can lead to overuse
• Excessive overhead activities such as carpenters and painters
• Bone spurs on the acromion
• Tendon degeneration due to ageing

Symptoms of Massive Rotator Cuff Tears

A massive tear is characterised by pain, increased weakness and disability. The pain may be worse at night or increase with activity and when lying on the affected side but can also occur at rest.

Complications of Massive, Retracted Rotator Cuff Tears

• Massive rotator cuff tears may be associated with:
• Fatty infiltration of muscle (accumulation of fats) causing loss of elasticity
• Humeral head subluxation (partial dislocation)
• Impingement of tissues
• Formation of bone spurs
• Osteoarthritis

Diagnosis of Massive, Retracted Rotator Cuff Tears

Your doctor will review your medical history and perform a physical examination to assess pain, movement, and strength. An MRI scan may be ordered to visualise the rotator cuff injury. X-rays may be performed to look at associated bone injuries or defects.

Treatment of Massive, Retracted Rotator Cuff Tears

Surgery is necessary to treat the most massive, retracted rotator cuff tears. Without treatment, shoulder movement becomes abnormal and structures within the shoulder can undergo further damage. Non-surgical treatment may be recommended for elderly patients with limited functional goals.

Surgical goals can often be achieved by arthroscopic surgery. The procedure is performed with the help of a pencil-sized instrument called an arthroscope that contains a miniature camera which relays images to a monitor. The procedure for massive tears usually involves:

• Extensive debridement of tissue fragments at the detached edge of the rotator cuff.
• Mobilisation to bring the detached muscle to its original attachment on the humerus.
• Reconstruction of the tendons with a suitable graft may be necessary.
• Attachment of the tendon to bone with the help of suture anchors.